Rapid exchange of a percutaneous gastrostomy tube during an early episode of COVID-19

We retrospectively report a case of rapid exchange of a percutaneous radiologic gastrostomy tube (balloon-occluded type catheter) via off-label use of a pigtail catheter for nutrition supply during a very early episode of coronavirus disease 2019 (COVID-19) in an outpatient clinic. This case demonstrates that minimally invasive percutaneous procedures might be provided safely and effectively under appropriate precautions for preventing COVID-19 transmission during the pandemic.Copyright © 2023, Society of Gastrointestinal Intervention.

Role of Chest Radiography as the Imaging Tool in COVID Pandemic Era

Background: The present radiological COVID literature is mainly confined to the CT findings. Using High Resolution Computed tomography (HRCT) as a regular 1st line investigation put a large burden on radiology department and constitute a huge challenge for the infection control in CT suite. Materials and Methods: A prospective study of 700 consecutive COVID positive cases who underwent Chest Xray (CXR) and HRCT thorax were included in the study. Many of these CXR were repeated and followed up over a duration of time to see the progression of disease. Results: 392/700 (56%) were found to be negative for radiological thoracic involvement. 147/700 (21%) COVID positive patients showed lung consolidations, 115/700 (16.5%) presented with GGO, 40/700 (5.7%) with nodules and 42/700 (6%) with reticular–nodular opacities. 150/700 patients (21.4 %) had mild findings with total RALE severity score of 1-2. More extensive involvement was seen in 104/700 (14.8 %) and 43/700 (6.2%) patients, who had severity scores of 3-4 and 5-6 respectively. 11/700 patients had a severity score of >6 on their baseline CXR. Those with severity score of 5 or more than 5 (54/700, 7.7%) required aggressive treatment with mean duration of stay of 14 days, many of them died also (23/54, 42.5%). Conclusion: In cases of high clinical suspicion for COVID-19, a positive CXR may obviate the need for CT. Additionally, CXR utilization for early disease detection and followup may also play a vital role in areas around the world with limited access to CT and RT-PCR test.

Analysis of Fifteen Approaches to Automated COVID-19 Detection Using Radiography Images

The COVID-19 pandemic has caused economic, physiological, and psychological harm to the world. A crucial step, hence, in the fight against covid is the highly efficient screening of patient cases. Conventional RT-PCR testing, even though more reliable, cannot be done on every patient as the virus has spread way faster than the world’s resources could afford. One very important screening approach that is being used across the globe is chest X-ray imaging. Since X-ray facilities are readily obtainable in healthcare systems of most countries across the globe, and with more and more X-ray systems being digitized, the cost and time of transportation are cut as well. Hence, if the detection of the virus in a CXR image can be automated using AI techniques, it will save a lot of time and effort of radiologists to have to go through hundreds of such images, and in some cases will also spare the need of doing RT-PCR testing, and since saving resources in this time is vital, automated detection can be very effective. In this work, we will explore, analytically discuss, and do a comparative study of many ML and deep learning techniques that have been taken for automated COVID-19 detection through chest X-rays (CXR). We carefully analyze the papers and derive a set of key factors for discriminating the methodologies, classification techniques, approaches, and the results that yielded. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Serum LDH: a potential surrogate to chest radiograph in pediatric Covid-19 patients to reduce radiation exposure

Background: Chest radiographs are frequently used to evaluate pediatric patients with COVID-19 infection during the current pandemic. Despite the minimal radiation dose associated with chest radiography, children are far more sensitive to ionizing radiation's carcinogenic effects than adults. This study aimed to examine whether serum biochemical markers could be potentially used as a surrogate for imaging findings to reduce radiation exposure. Methods: The retrospective posthoc analysis of 187 pediatric patients who underwent initial chest radiographs and serum biochemical parameters on the first day of emergency department admission. The cohort was separated into two groups according to whether or not the initial chest radiograph revealed evidence of pneumonia. Spearman's rank correlation was used to connect serum biochemical markers with observations on chest radiographs. The Student's t-test was employed for normally distributed data, and for non-normally distributed data, the Mann–Whitney U test was used. A simple binary logistic regression was used to determine the importance of LDH in predicting chest radiographs. The discriminating ability of LDH in predicting chest radiographs was determined using receiver operating characteristics (ROC) analysis. The cut-off value was determined using Youden's test. Interobserver agreement was quantified using the Cohen k coefficient. Results: 187 chest radiographs from 187 individual pediatric patients (95 boys and 92 girls;mean age ± SD, 10.1 ± 6.0 years;range, nine months–18 years) were evaluated. The first group has 103 patients who did not have pneumonia on chest radiographs, while the second group contains 84 patients who had evidence of pneumonia on chest radiographs. GGO, GGO with consolidation, consolidation, and peri-bronchial thickening were deemed radiographic evidence of pneumonia in group 2 patients. Individuals in group 2 with radiological indications of pneumonia had significantly higher LDH levels (p = 0.001) than patients in group 1. The Spearman's rank correlation coefficient between LDH and chest radiography score is 0.425, showing a significant link. With a p-value of < 0.001, the simple binary logistic regression analysis result validated the relevance of LDH in predicting chest radiography. An abnormal chest radiograph was related to LDH > 200.50 U/L (AUC = 0.75), according to the ROC method. Interobserver agreement between the two reviewers was almost perfect for chest radiography results in both groups (k = 0.96, p = 0.001). Conclusion: This study results show that, compared to other biochemical indicators, LDH has an 80.6% sensitivity and a 62% specificity for predicting abnormal chest radiographs in a pediatric patient with confirmed COVID-19 infection. It also emphasizes that biochemical measures, rather than chest radiological imaging, can detect the pathogenic response to COVID-19 infection in the chest earlier. As a result, we hypothesized LDH levels might be potentially used instead of chest radiography in children with COVID-19, reducing radiation exposure.

Bedside cannulation for veno-venous extracorporeal membrane oxygenation using portable X-ray system in a coronavirus disease patient.

Transportation of patients with coronavirus disease (COVID)-19 outside isolation rooms should be avoided to prevent further spread of the disease. Here, we report a safe and accurate bedside cannulation method for veno-venous extracorporeal membrane oxygenation (VV-ECMO) in a COVID-19 patient in the intensive care unit. A 71-year-old man was admitted to our hospital and diagnosed as having COVID-19 pneumonia. We decided to initiate VV-ECMO therapy because maintaining blood oxygen saturation was difficult despite the mechanical ventilation. We placed two flat-panel detectors behind the patient's chest and the right inguinal area. We repeatedly imaged and monitored insertion of wires and cannulas using a portable X-ray system. Cannulas were successfully inserted in the appropriate position, and VV-ECMO was initiated without any complications. .