Role of telemedicine in anesthesia: Are we ready yet?

Telemedicine is a modality which utilizes technology to provide and support health care across large distances. It has redefined the practices of medicine in many specialties and continues to be a boon for clinicians on many frontiers. Its role in the branch of anesthesia remains largely unexplored but has shown to be beneficial in all the three phases: pre-operative, intra-operative, and post-operative. Now time has come that anesthesiologists across the globe reassess their strategies and utilize the telemedicine facilities in the field of anesthesia.Copyright © 2021 EDP Sciences. All rights reserved.

Sars cov-2 infection in a neonate in ghana: A case report

Backgrounds: The clinical and socioeconomic effects of COVID-19 are still being felt through-out the world. The disease affects people of all age groups, but it is known to have a milder clinical course in children including neonates. There is paucity of data from Sub-Saharan Africa on neonatal COVID-19 infection, and no such case has been reported in the literature in Ghana. Case presentation: This study presented a case report of a neonate who was found to be positive for COVID-19 infection after presenting symptoms such as respiratory distress, rhinorrhoea, and cough. This neonate was managed with in-hospital standard protocol for sepsis with a focus on pneumonia. Conclusion(s): The national guidelines on COVID-19 management were used for the neonate who was recovered and discharged.Copyright © 2021, TMU Press.

A rare case of central post-stroke pain in a patient with migraine and lacunar infarcts in the medulla oblongata

Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Streptococcus Anginosus Causing Infective Endocarditis - a Rare Case of Multiple Splenic Infarctions

Background Information on infective endocarditis (IE) caused by the Streptococcus anginosus (S. anginosus) group is scarce. We present a case of IE with multiple splenic septic infarcts that was further complicated by renal involvement and osteomyelitis, caused by S. anginosus in a patient with diabetes. Case 58-year-old male with diabetes presented with fever and bilateral flank pain. His CT showed splenomegaly with multiple splenic infarctions and symmetric bilateral perinephric stranding indicative of nephritis. His Labs showed leukocytosis and two blood culture sets grew S.anginosus. Transesophageal echocardiogram confirmed vegetations on aortic valve (1.3 x 1.0 cm)(Image A, red arrow) and mitral valve (1.4 x 1.0 cm)(Image B, blue arrow). Lumbar spine MRI showed L2-3 vertebral osteomyelitis. [Formula presented] Decision-making Due to patient's normal oxygen saturation and clear lung auscultation and imaging, COVID-19 was ruled out. The etiology of his fever was diagnosed as S. anginosus IE, as evidenced by his vegetations and positive cultures. The patient started on IV antibiotics and IV fluids and was transferred to another facility to receive aortic and mitral bioprostheses. Conclusion This, to the best of our knowledge, is the first documented case of S. anginosus with splenic and renal involvement. The presence of multiple splenic infarcts in immunocompromised patients, in this case in someone with diabetes, should raise suspicion for the presence of vegetations and the diagnosis of S. anginosus IE.Copyright © 2023 American College of Cardiology Foundation

Clinical Characteristics of Hemodialysis Patients Hospitalized with Covid-19: A Case Series of 70 Cases from Dominican Republic

Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Method(s): This is a retrospective study in chronic hemodialysis patients hospitalized with COVID-19. All patients diagnosed with COVID-19 from March 2020 to January 2022 are included. Result(s): The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were hypertension (98.6%) and type 2 diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as procalcitonin, erythrocyte sedimentation rate (ESR), D-dimer and C-reactive protein (CRP) were the main prevalent lab findings. At admission 90.1% had ground- glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days;35.7% of these patients were admitted to the ICU and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Conclusion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No significant adverse effects were observed with remdesivir in these patients, so we believe that its use is beneficial in conjunction with the use of statins and antithrombotic prophylaxis, based on the patient's requirements. No conflict of interestCopyright © 2023

A CASE OF LOMUSTINE-INDUCED PNEUMONITIS

SESSION TITLE: Drug-Induced Lung Injury and Disease SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Lomustine, a nitrosurea, inhibits DNA, RNA, and protein synthesis by carbamylation and alkylation, leading to cytotoxic effects 1, 3. Its concentration is high in the central nervous system (CNS) and therefore is commonly used for the management of CNS tumors including recurrent glioblastoma. While known side effects include pancytopenia, few pulmonary toxicities have been reported. This case is a rare example of lomustine induced pneumonitis. CASE PRESENTATION: A 54-year-old female with a history of glioblastoma, treated with a combination of surgical resection, radiation therapy, and temozolomide followed by stereotactic surgery and bevacizumab after disease recurrence, developed progressive dyspnea after initiating lomustine. She had received one dose of lomustine 90 mg/m2 two months prior to developing dyspnea upon exertion. At baseline, she was an active individual who played sports. A chest computed tomography (CT) scan preformed ten months prior was without any parenchymal abnormalities, and pulmonary function tests (PFTs) two months prior were normal with an adjusted DLCO of 15.4 mL/mmHg/min (88%). Repeat chest CT revealed diffuse ground glass opacities, and repeat PFTs showed a moderately impaired adjusted DLCO of 10.4 mL/mmHg/min (60%). Other lab evaluation, CBC, BNP, troponin, and COVID PCR, were negative. After receiving six weeks of steroids, there was resolution of CT findings, improvement of DLCO, and relief from symptoms. DISCUSSION: More common adverse effects of lomustine are GI discomfort and pancytopenia. It is less widely documented to cause pulmonary toxicity compared to its chemical relative carmustine 1, 3. This is perhaps due to decreased alkylation ability and penetration into the lung tissue by lomustine7. There have been few case reports revealing pneumonitis and pulmonary fibrosis. Lomustine induced pneumonitis induces acute parenchymal changes of the lung demonstrated by characteristic symptoms and imaging/biopsies abnormalities after initiation of a drug. 2 Findings include breathlessness, dyspnea upon exertion, cough, hypoxia, crackles upon lung auscultation. PFT's may show a restrictive pattern with decreased FEV1/FVC ratio and DLCO. Imaging may reveal diffuse groundglass opacities, traction bronchiectasis, interlobular septal thickening, and honeycombing. Bronchoscopy with lavage would rule out infection. Management involves discontinuation of culprit medication, immunosuppression, and supportive therapies to alleviate respiratory discomfort. Lack of treatment may produce complications of acute respiratory distress syndrome and fibrosis. CONCLUSIONS: Lomustine is an essential treatment drug for recurrent CNS tumors. Toxicities such as pneumonitis have been rarely demonstrated. Timely recognition of pneumonitis features is key to treat this complication, improve quality of life, and prevent permanent lung compromise. Reference #1: Dent RG. Fatal pulmonary toxic effects of lomustine. British medical journal. 1982;DOI:10.1136/thx.37.8.627 Reference #2: Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton, C, et al. Drug-Induced Interstitial Lung Disease: A Systemic Review. Journal of Clinical Medicine. 2018;doi 10.3390/jcm7100356 Reference #3: Weiss RB, Issell BF. The nitrosureas: carmustine and lomustine. Cancer treatment reviews. 1982;https://doi.org/10.1016/S0305-7372(82)80043-1 DISCLOSURES: No relevant relationships by Sukhdeep Kaur No relevant relationships by Chelsea Kennedy-Snodgrass No relevant relationships by Sarun Thomas

AN UNUSUAL CASE OF COVID-19 COMPLICATED BY POSSIBLE ACUTE EOSINOPHILIC PNEUMONIA

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure. AEP has been reported in association with smoking, drugs, and infections. Very few reports of AEP accompanied by Coronavirus disease 2019 (COVID-19) exist in current literature. Here we describe a case of AEP in association with COVID-19. CASE PRESENTATION: A 58-year-old female, non-smoker, with no medical history presented to the emergency room with fever, cough, and shortness of breath for 10 days. She received two doses of vaccine against COVID-19. Her vital signs were notable for oxygen saturation of 56% on room air and respiratory rate of 35 breaths per minute. Her physical exam was notable for distress, tachypnea, and diffuse rhonchi on lung auscultation. Her chest x-ray showed multifocal bilateral peripheral and basilar airspace opacities. A respiratory pathogen panel detected SARS-CoV-2. She was admitted to the medical intensive care unit and suffered worsening acute hypoxemic respiratory failure requiring intubation. She was treated with dexamethasone 6mg for a 10-day course with gradually decreasing oxygen requirements, and she underwent tracheostomy on hospital day 11. Despite this, she continued to deteriorate clinically. Review of laboratory results showed significant eosinophilia of 15.6% on her complete blood count upon withdrawal of steroids. A CTA scan of the chest showed no evidence of pulmonary embolic disease and demonstrated bilateral extensive dense consolidations. A diagnosis of acute eosinophilic pneumonia was suspected. Fungal cultures and stool ova and parasites were negative. She was started on methylprednisolone 1mg/kg and a bronchoscopy was performed with bronchioalveolar lavage (BAL) samples showing 4% eosinophils despite high dose steroid therapy. She was continued on high dose steroids with rapid improvement in her oxygen requirements. DISCUSSION: AEP is an acute febrile illness that can lead to acute respiratory failure. The presence of dense infiltrates in the early stages of COVID-19 and elevated inflammatory markers and reticence to perform bronchoscopy can delay making a diagnosis of AEP in a patient diagnosed with COVID19. The diagnostic hallmark of AEP is the detection of > 25% eosinophils in BAL samples. While this patient did not meet that criterion, she received high dose corticosteroids which may have suppressed pulmonary eosinophilia. A high index of suspicion for AEP should be maintained in patients with COVID-19 with evidence of eosinophilia and clinical deterioration, given that AEP improves rapidly with the appropriate treatment. CONCLUSIONS: AEP is an uncommon cause of respiratory failure that should be considered in patients with unexplained worsening respiratory status and evidence of eosinophilia. Bronchoscopy with bronchoalveolar lavage should be considered early, even in the setting of COVID-19 in patients without risk factors who develop severe disease. Reference #1: De Giacomi F, Vassallo R, Yi ES, Ryu JH. Acute Eosinophilic Pneumonia. Causes, Diagnosis, and Management. Am J Respir Crit Care Med. 2018;197(6):728-736. doi:10.1164/rccm.201710-1967CI Reference #2: Murao K, Saito A, Kuronuma K, Fujiya Y, Takahashi S, Chiba H. Acute eosinophilic pneumonia accompanied with COVID-19: a case report. Respirol Case Rep. 2020;8(9): e00683. Published 2020 Nov 16. doi:10.1002/rcr2.683 DISCLOSURES: No relevant relationships by Hadya Elshakh No relevant relationships by Christina Jee Ah Rhee no disclosure on file for Lourdes Sanso;

SLE ONSET POST COVID-19 VACCINATION: COINCIDENTAL or ASSOCIATION?

Background: Numerous immune-mediated diseases fare or new disease onset after SARS-CoV2-vaccination have been reported. There were case reports showed the immune-mediated disease fare post vaccination but study on new disease occurs post Covid-19 vaccination is still lacking. Objectives: To describe two SLE cases that diagnosed post Covid-19 vaccination. Methods: Case report Results: 14 years old girl, post Covid-19 vaccination 1st dose 3 weeks ago presented with 2 day history of giddiness, breathlessness, vomiting and diarrhea prior to admission. She also complained of frothy urine for the past 1 week associated with lower limbs swelling and facial puffiness. Clinical examination noted she had sparse hair, oral ulcers and discoid lupus at the ear concha. She also noted to have periorbital puffiness with pedal edema. Lung auscultation noted bi-basal crepitations. Blood investigation noted ANA positive (1:640, speckled) with low complement 3 (0.1g/L). Her full blood count showed leucopenia (3100 UL) with low lymphocyte count of 810UL. UFEME noted protein of 3 + and red blood cell of 2+ with normal renal profile. Her serum albumin was 22g/L. Chest x ray showed clear lung field with no cardiomegaly. Her 24-hour urine protein showed proteinuria of 2.345g/dl and her renal biopsy showed mesangial proliferative lupus nephritis class iI. She was given intravenous methyl-prednisolone 500mg OD for 3 days and discharged with tapering dose of prednisolone, hydroxychloroquine, calcium supplements, perindopril and frusemide. Another case was a 17 year-old female, post covid-19 vaccination 10 weeks, presented with 3 weeks history of bilateral lower limbs weakness with difficulty in getting up from chair. She also had fever on and off with cough for 1 week. There was no alopecia, oral ulcer, facial rash or photosensitivity. No joints pain. Clinical examination noted presence of proximal myopathy with stable vital signs. Other systemic examinations were unremarkable. Blood investigation noted ANA positive (1: 640, homogenous and speckled) with low complements level (C3 0.19g/L and C4 0.049 g/L).Her creatine kinase was 2367U/L and EMG showed evidence of irritable myopathic process which is consistent with inflammatory myositis. Her TFT was normal. Myositis panel showed anti-Ku and anti-Ro 52 were positive. She was treated as SLE with myositis and intravenous methylprednisolone was given. She discharge well with tapering dose of prednisolone and azathioprine. Her creatine kinase showed improvement with immunosuppression therapy and she was advised on intensive physiotherapy. Conclusion: The onset of these two SLE cases were occurred within the 2 month of post covid-19 vaccination. Whether Covid-19 vaccination direct contribute to the occurrence of SLE remained inconclusive. More studies are required to show its correlation between onset of SLE and Covid-19 vaccination.

Perioperative Concerns for Patients with Prior SARS-CoV-2 Infection: Our Experience

Methodology and case description: Case 1: A 55-year-old hypertensive male with complaints of chest pain presented to the cardiology department. He underwent angiography to reveal triple vessel disease and was scheduled for coronary artery bypass graft surgery. During preoperative evaluation, patient gave a history of having suffered from mild COVID-19, getting cured with conservative management under home isolation 3 months back. Examination revealed bilateral basal crepitations. Chest X-ray was indicative of fibrosis basal areas of both lungs (right > left) which was confirmed by HRCT chest. Preoperatively the patient was optimised with antifibrotic agent nintedanib and methylprednisolone. He was reviewed after 1 month and had shown significant-resolution radiologically as well as clinically (improved breath holding time, saturation and lung auscultation). Intraoperative course was uneventful and the patient was ventilated with low tidal volume. Postoperatively, the patient was extubated on day 1. Patient experienced difficulty in expectoration which was improved by N-acetyl cysteine administered intravenously and via nebulisation along with active vigorous physiotherapy. Patient was discharged on the 7th postoperative day. Case 2: A 37-yearold female, a known case of severe mitral stenosis, moderate pulmonary hypertension, moderate tricuspid regurgitation was under conservative management with diuretics and beta-blockers and was being planned for mitral valve replacement. The patient had developed COVID-19 infection 1 month back and was treated under home isolation and conservative management. However, the patient presented with an increase in exercise intolerance post COVID infection. Suspecting the possibility of fluid overload/ heart failure and pulmonary hypertension, the diuretic dose was increased post admission, but to no avail. Chest X-ray and HRCT chest were done which highlighted the possibility of allergic bronchopulmonary aspergillosis;which has been described as one of the rare findings coexisting with active COVID-19 infection. This was confirmed by the serum IgE levels and presence of eosinophilia in the complete blood picture. The patient was initiated on itraconazole and methylprednisolone which resulted in improvement in breathlessness over the next 3 weeks. The patient was subsequently posted for surgical replacement of the mitral valve. Intra-operative and post-operative course was uneventful and the patient was discharged on 5th post-operative day. Conclusion: These 2 cases who had suffered from mild COVID-19 infection presented significant challenges for safe intra- and post-operative conduct of anaesthesia. These challenges were overcome by efficient prehabilitation and optimisation of the patient and optimal post-operative critical care. Intra-operative course is often just a small segment of the overall hospital course of the patient and the role of critical care in the pre-surgical, extra-hospital care along with post-operative care needs acknowledgement and recognition.

Deep Vein Thrombosis, Septic Pulmonary Emboli and Methicillin-Resistant Staphylococcal Aureus Bacteremia Complicated by a Furuncle in a Child

Staphylococcal aureus infection in children is a major public health problem globally. It causes a varied spectrum of clinical disease including bacteremia, endocarditis, skin and soft tissue infection, pleuro-pulmaonry and osteo-articular infection. Deep vein thrombosis (DVT) is a known complication of staphylococcal infection. We report a case series which included, 10-year old boy developed DVT, septic pulmonary emboli and Methicillin-resistant Staphylococcal aureus (MRSA) bacteremia following a furuculosis and 13 year old girl with thrombosis of internal and external jugular vein, cavernous sinus with pulmonary emboli and MRA bacteremia. Both patients are previously healthy showed complete recovery after aggressive appropriate antibiotics, anticoagulants and supportive care. The high index of suspicion of DVT in MRSA infection is needed, prompt diagnosis and aggressive appropriate therapies improve the outcomes and minimize the complications.

Bioacoustic signal analysis through complex network features.

The paper proposes a graph-theoretical approach to auscultation, bringing out the potential of graph features in classifying the bioacoustics signals. The complex network analysis of the bioacoustics signals - vesicular (VE) and bronchial (BR) breath sound - of 48 healthy persons are carried out for understanding the airflow dynamics during respiration. The VE and BR are classified by the machine learning techniques extracting the graph features - the number of edges (E), graph density (D), transitivity (T), degree centrality (Dcg) and eigenvector centrality (Ecg). The higher value of E, D, and T in BR indicates the temporally correlated airflow through the wider tracheobronchial tract resulting in sustained high-intense low-frequencies. The frequency spread and high-frequencies in VE, arising due to the less correlated airflow through the narrow segmental bronchi and lobar, appears as a lower value for E, D, and T. The lower values of Dcg and Ecg justify the inferences from the spectral and other graph parameters. The study proposes a methodology in remote auscultation that can be employed in the current scenario of COVID-19.

Case Report of 78-Year-Old Man With Meningitis, Pulmonary Thromboembolism and SARS-Coronavirus-2 Infection

The novel coronavirus infection involves both the Central and Peripheral Nervous systems. Some of the presentations include acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis, and epilepsy. Our patient was a 78-year-old man with dementia and diabetic nephropathy who was admitted two times for possibly COVID-19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and Kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID-19. After the negative RT-PCR test of the nasopharyngeal sample for COVID-19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever, and hypoxemia in the physical exam;he had neck stiffness in all directions, So the central nervous system (CNS) infection was suspected, the cerebrospinal fluid (CSF) sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID-19 was positive, but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet been reported. Our patient is the first one, so we decided to share it. This case showed a different presentation of COVID-19 without typical lung involvement. So, we must pay attention to any signs and symptoms in a patient suspected of having a COVID-19.

The Utility of Real-Time Remote Auscultation Using a Bluetooth-Connected Electronic Stethoscope: Open-Label Randomized Controlled Pilot Trial.

BACKGROUND: The urgent need for telemedicine has become clear in the COVID-19 pandemic. To facilitate telemedicine, the development and improvement of remote examination systems are required. A system combining an electronic stethoscope and Bluetooth connectivity is a promising option for remote auscultation in clinics and hospitals. However, the utility of such systems remains unknown. OBJECTIVE: This study was conducted to assess the utility of real-time auscultation using a Bluetooth-connected electronic stethoscope compared to that of classical auscultation, using lung and cardiology patient simulators. METHODS: This was an open-label, randomized controlled trial including senior residents and faculty in the department of general internal medicine of a university hospital. The only exclusion criterion was a refusal to participate. This study consisted of 2 parts: lung auscultation and cardiac auscultation. Each part contained a tutorial session and a test session. All participants attended a tutorial session, in which they listened to 15 sounds on the simulator using a classic stethoscope and were told the correct classification. Thereafter, participants were randomly assigned to either the real-time remote auscultation group (intervention group) or the classical auscultation group (control group) for test sessions. In the test sessions, participants had to classify a series of 10 lung sounds and 10 cardiac sounds, depending on the study part. The intervention group listened to the sounds remotely using the electronic stethoscope, a Bluetooth transmitter, and a wireless, noise-canceling, stereo headset. The control group listened to the sounds directly using a traditional stethoscope. The primary outcome was the test score, and the secondary outcomes were the rates of correct answers for each sound. RESULTS: In total, 20 participants were included. There were no differences in age, sex, and years from graduation between the 2 groups in each part. The overall test score of lung auscultation in the intervention group (80/110, 72.7%) was not different from that in the control group (71/90, 78.9%; P=.32). The only lung sound for which the correct answer rate differed between groups was that of pleural friction rubs (P=.03); it was lower in the intervention group (3/11, 27%) than in the control group (7/9, 78%). The overall test score for cardiac auscultation in the intervention group (50/60, 83.3%) was not different from that in the control group (119/140, 85.0%; P=.77). There was no cardiac sound for which the correct answer rate differed between groups. CONCLUSIONS: The utility of a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope was comparable to that of direct auscultation using a classic stethoscope, except for classification of pleural friction rubs. This means that most of the real world's essential cardiopulmonary sounds could be classified by a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope. TRIAL REGISTRATION: UMIN-CTR UMIN000040828; https://tinyurl.com/r24j2p6s and UMIN-CTR UMIN000041601; https://tinyurl.com/bsax3j5f.

Validity of Lung Ultrasound: Is an Image Worth More Than a Thousand Sounds?

INTRODUCTION: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. METHODOLOGY: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). RESULTS: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B-lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. CONCLUSIONS: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.

Evidence of the Sequential Changes of Lung Sounds in COVID-19 Pneumonia Using a Novel Wireless Stethoscope with the Telemedicine System.

A 60-year-old woman was admitted to our hospital due to coronavirus disease 2019 (COVID-19) pneumonia with a chief complaint of persistent low-grade fever and dry cough for two weeks. Thoracic computed tomography demonstrated a crazy paving pattern in the bilateral lower lobes. In a COVID-19 ward, we used a novel wireless stethoscope with a telemedicine system and successfully recorded and shared the lung sounds in real-time between the red and green zones. The fine crackles at the posterior right lower lung fields changed from mid-to-late (day 1) to late inspiratory crackles (day 3), which disappeared at day 5 along with an improvement in both the clinical symptoms and thoracic CT findings.