Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer: An observational study from a tertiary care center in North India

Background: Patients with cancer are at a higher risk of getting infected with the severe acute respiratory syndrome coronavirus 2 owing to their immunocompromised state. Providing care to these patients amidst the first wave of the coronavirus disease-2019 (COVID-19) pandemic was extremely challenging. Objective(s): This study was aimed at evaluating the clinical profile and disease-related outcomes of pediatric patients with hematological illnesses and cancer. Material(s) and Method(s): This retrospective study was conducted at a tertiary care center in North India during the first wave of the pandemic from March 2020 to December 2020. Children aged up to 18 years, who were treated for a hematological illness or malignancy or underwent hematopoietic stem cell transplantation (HSCT) and tested positive for COVID-19 regardless of symptoms were included in the study. Baseline demographic data related to the age, diagnosis, treatment status, and chemotherapy protocol used were collected. Outcomes including the cure rates, comorbidities, and sequelae were recorded. Result(s): A total of 650 tests for COVID-19 were performed for 181 children;22 patients were found to be COVID-19 positive. The most common diagnosis was acute leukemia (63.6%). None of the patients developed COVID-19 pneumonia. The majority of patients had asymptomatic infection and were managed at home. Among those with a symptomatic infection, the most common symptoms were fever and cough. A total of 3 (13.6%) patients needed oxygen therapy, one developed multisystem inflammatory syndrome of children leading to cardiogenic shock. Three patients required intensive care or respiratory support;all the patients had favorable clinical outcomes. The median time from the onset of COVID-19 to a negative result on the reverse transcription-polymerase chain reaction test was 21.3 days. Cancer treatment was modified in 15 patients (68.2%). Conclusion(s): Our results suggest that children with hemato-oncological illnesses rarely experience severe COVID-19 disease. The impact of the first wave of COVID-19 primarily manifested as disruptions in the logistic planning and administration of essential treatment to these children rather than COVID-19 sequelae.Copyright © 2021 Cancer Research, Statistics, and Treatment Published by Wolters Kluwer - Medknow.

Comparison between original SARS-CoV-2 strain and omicron variant on thin-section chest CT imaging of COVID-19 pneumonia.

OBJECTIVES: We investigated different computed tomography (CT) features between Omicron-variant and original-strain SARS-CoV­2 pneumonia to facilitate the clinical management. MATERIALS AND METHODS: Medical records were retrospectively reviewed to select patients with original-strain SARS-CoV­2 pneumonia from February 22 to April 22, 2020, or Omicron-variant SARS-CoV­2 pneumonia from March 26 to May 31, 2022. Data on the demographics, comorbidities, symptoms, clinical types, and CT features were compared between the two groups. RESULTS: There were 62 and 78 patients with original-strain or Omicron-variant SARS-CoV­2 pneumonia, respectively. There were no differences between the two groups in terms of age, sex, clinical types, symptoms, and comorbidities. The main CT features differed between the two groups (p = 0.003). There were 37 (59.7%) and 20 (25.6%) patients with ground-glass opacities (GGO) in the original-strain and Omicron-variant pneumonia, respectively. A consolidation pattern was more frequently observed in the Omicron-variant than original-strain pneumonia (62.8% vs. 24.2%). There was no difference in crazy-paving pattern between the original-strain and Omicron-variant pneumonia (16.1% vs. 11.6%). Pleural effusion was observed more often in Omicron-variant pneumonia, while subpleural lesions were more common in the original-strain pneumonia. The CT score in the Omicron-variant group was higher than that in the original-strain group for critical-type (17.00, 16.00-18.00 vs. 16.00, 14.00-17.00, p = 0.031) and for severe-type (13.00, 12.00-14.00 vs 12.00, 10.75-13.00, p = 0.027) pneumonia. CONCLUSION: The main CT finding of the Omicron-variant SARS-CoV­2 pneumonia included consolidations and pleural effusion. By contrast, CT findings of original-strain SARS-CoV­2 pneumonia showed frequent GGO and subpleural lesions, but without pleural effusion. The CT scores were also higher in the critical and severe types of Omicron-variant than original-strain pneumonia.

CLINICO-RADIOLOGICAL EVALUATION AND CORRELATION OF HRCT CHEST IMAGING FINDINGS WITH DISEASE STATUS IN COVID-19 PATIENTS

Background: High-resolution computed tomography (HRCT) chest is rapid and has a strong sensitivity for diagnosing viral pneumonia including COVID 19 disease in its early stages in comparison to RT-PCR, thus being crucial in triaging patients for treatment and isolation, to prevent further transmission of the disease. In this study we are going to analyse the temporal changes in imaging findings of COVID-19 on HRCT chest. Methods: prospective study was conducted in the Department of Radiology of an exclusive 500 bedded COVID Hospital in Bhubaneswar, Odisha, India. Evaluation of hundred patients was done based on inclusion and exclusion criteria, after obtaining informed consent over a period of 2 years from September 2020 to September 2022. All pertinent epidemiological data was gathered from hospital records. All COVID 19 RT-PCR positive patients who underwent HRCT Chest on admission and repeat scan within 30 days, following the progression of the disease were included. Those who were clinically suspected COVID cases but were RT PCR negative on RT-PCR testing, were excluded. Results: HRCT chest demonstrated diffuse ground glass opacities to be the predominant finding (55%) with the associated findings of sub pleural atelectatic bands (31%) and septal thickening (23%). There was a positive correlation of blood parameters like CRP in COVID patients. A higher incidence was found in patients with Type-2 diabetes mellitus, followed by those with hypertension. In majority of the cases (80%) bilateral lungs and in about 81% cases, two or more lung lobes were involved. Mild and moderately ill patients were found to have a CTSS (CT severity score) in the score range of 15-25. Typical category was the most common type followed by atypical and indeterminate categories. Conclusions: 'Typical pattern' along with diffuse ground glass opacities of multiple lobes in the HRCT chest was the most common pattern of lung involvement. High Computer Tomography Severity Score (CTSS) corresponds to a higher disease severity, which helps in taking a timely decision for early treatment. HRCT Thorax has early and fast diagnostic capability as compared to RT-PCR in the detection of COVID-19. The elderly and those with comorbidities are at a higher risk of developing severe disease. Blood parameters like CRP can be used for disease monitoring and follow-up purposes. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Diagnosing the acute abdomen during a global contrast shortage: a single centre experience.

BACKGROUND: The COVID-19 pandemic led to a global shortage of iodinated contrast media (ICM) in early 2022. ICM is used in more than half of the computed tomography of the abdomen and pelvis (CTAP) performed to diagnose an acute abdomen (AA). In response to the shortage, the RANZCR published contrast-conserving recommendations. This study aimed to compare AA diagnostic outcomes of non-contrast CTs performed before and during the shortage. METHODS: A single-centre retrospective observational cohort study of all adult patients presenting with an AA who underwent a CTAP was conducted during the contrast shortage period from May to July 2022. The pre-shortage control comparison group was from January to March 2022; key demographics, imaging modality indication and diagnostic outcomes were collected and analysed using SPSS v27. RESULTS: Nine hundred and sixty-two cases met the inclusion criteria, of which n = 502, 52.2% were in the shortage period group. There was a significant increase of 464% in the number of non-contrast CTAPs performed during the shortage period (P < 0.001). For the six AA pathologies, only n = 3, 1.8% of non-contrast CTAPs had equivocal findings requiring further imaging with a contrast CTAP. Of the total CTs performed, n = 464, 48.2% were negative. CONCLUSION: This study showed that when non-contrast CTs are selected appropriately, they appear to be non-inferior to contrast-enhanced CTAPs in diagnosing acute appendicitis, colitis, diverticulitis, hernia, collection, and obstruction. This study highlights the need for further research into utilizing non-contrast scans for assessing the AA to minimize contrast-associated complications.

Diagnostic value of blood oxygen saturation and C-Reactive Protein (CRP) in Predicting Lung Sequels in COVID-19 infected patients admitted to hospital: A 12-week cohort study

Background: Evidence of COVID-19 respiratory sequels is restricted and predisposing factors are not well studied more than two years passing pandemic. This study followed COVID-19 patients 12 weeks after discharge from hospital for respiratory sequels. Material(s) and Method(s): This was a prospective study on discharged COVID-19 patients in 2021, in Jahrom, Iran. Exposure was COVID-19 clinical features at hospitalization, including symptoms and physical examination and laboratory findings, and primary endpoint was 12-week lung sequel, being evaluated by a chest CT scan. Demographics and previous medical history were considered covariates. SPO2and CRP 6-week changes were followed as an early tool for prediction of 12-week lung sequel. Result(s): Totally, 383 participants (17 had sequels) with mean age of 57.43 18.03 years old (50.13% male) completed 12-week study follow-ups. Ninety-one (23.8%) subjects had an ICU admission history. SPO2% in 6th week was statistically significantly associated with a higher rate of 12-week sequelae (p<0.001). Also, patients having CT scan scores between 40% to 50% (p=0.012) and higher than 50% (p=0.040) had higher chance of experiencing lung sequelae than patients with CT scan score of below 40%, as well as having ICU admission history and lower SPO2% at 6th week of discharge. There was a statistically significant increasing trend of SPO2% (P<0.001) and a statistically significant decreasing trend of CRP levels (P<0.001), overall. SPO2% increase after 6 weeks was lower in participants with lung sequels than fully improved ones (P=0.002) and as well as total 12-week change in SPO2% (P=0.001). CRP changes in none of evaluated periods were different among study groups (P>0.05). Conclusion(s): Our results were in favor of closely following SPO2levels after patient discharge, while CRP assessment seems not helpful based on our results [GMJ.2023;12:e2695].Copyright © 2023 Shiraz University of Medical Sciences. All rights reserved.

Rituximab in the Treatment of Idiopathic Inflammatory Myopathies with Interstitial Lung Disease, Long-Term Follow-Up

Background. Interstitial lung disease (ILD) is the common internal organ manifestation of idiopathic inflammatory myopathies (IIM) that can severely affect the course and prognosis of the disease. Rituximab (RTX) has been used to treat IIM, including variants with ILD. Objectives. To describe the course of disease in IIM patients with ILD, treated with RTX in long-term follow-up. Methods. Our prospective study included 35 pts with IIM fulfilling Bohan and Peter criteria and having ILD. The mean age was 51.8+/-11.9 years, female-26 pts (74%);24 (68.5%) with antisynthetase syndrome, 5 (14.3%) dermatomyositis (DM), 5 (14.3%) with a-Pm/Scl overlap myositis and 1 (2,9%) with a-SRP necrotizing myopathy were included. 25 (71,4% ) patients had nonspecific interstitial pneumonia, 9 (25,7%) organizing pneumonia (OP) and 1 (2,9%) OP, transformed to diffuse alveolar damage. All pts had the standard examination including manual muscle testing (MMT), creatinkinase (CK) anti-Jo-1 antibodies (anti-Jo-1) assay;forced vital capacity (FVC) and carbon monoxide diffusion capacity (DLCO) evaluation as well as high-resolution computed tomography (HRCT) scanning of the chest were performed at baseline, and 36 and more months. The median disease duration was 3.2 [0.16-18] years, 21 (60%) of pts were positive for a-Jo-1 antibody. All pts received prednisolone at a mean dose of 24.3+/-13 mg/day, immunosupressants at inclusion received 25 (71%) pts: cyclophosphamide 18 , mycophenolate mofetil 6 and comdination 1;Rituximab (RTX) was administered in case of severe course of disease and intolerance or inadequate response to GC and other immunosuppressive drugs. Results. The mean follow-up period after the first infusion of RTX was 47.2+/-11.9 months. Pts received 1-11 courses of RTX . The cumulative mean dose of RTX was 4.6 +/-2.5g. MMT 8 increased from 135.8+/-13.5 to 148.75+/-3.5 (p=0.000001). CK level decreased DELTACK - 762 u/l(median 340;25th% 9;75th% 821). anti-Jo-1 decreased from 173.4+/-37 to 96.5+/-79 u/ml (p=0.00002), FVC increased from 82+/-22.6 to 96,9+/-22% (p=0.00011). DLCO increased from 51.4+/-15.2 to 60+/-77.8% (p=0.0001). The mean prednisone dose was reduced from 24.3+/-13 to 5.7+/-2.4 mg/day. 3 pts died: ILD progression was the cause of death in 1 case, 1 bacterial pneumonia and COVID19 pneumonia. Conclusions. The results of this study confirm the positive effect of RTX in IIM patients with ILD (increase of muscle strength and improve lung function, decrease in anti-Jo-1 levels) and also its good steroid-sparing effect. RTX could be considered as an effective drug for the complex therapy of IIM patients with ILD when standard therapy is ineffective or impossible.

Superior possibilities and upcoming horizons for nanoscience in COVID-19: noteworthy approach for effective diagnostics and management of SARS-CoV-2 outbreak.

The outbreak of COVID-19 has caused great havoc and affected many parts of the world. It has imposed a great challenge to the medical and health fraternity with its ability to continue mutating and increasing the transmission rate. Some challenges include the availability of current knowledge of active drugs against the virus, mode of delivery of the medicaments, its diagnosis, which are relatively limited and do not suffice for further prognosis. One recently developed drug delivery system called nanoparticles is currently being utilized in combating COVID-19. This article highlights the existing methods for diagnosis of COVID-19 such as computed tomography scan, reverse transcription-polymerase chain reaction, nucleic acid sequencing, immunoassay, point-of-care test, detection from breath, nanotechnology-based bio-sensors, viral antigen detection, microfluidic device, magnetic nanosensor, magnetic resonance platform and internet-of-things biosensors. The latest detection strategy based on nanotechnology, biosensor, is said to produce satisfactory results in recognizing SARS-CoV-2 virus. It also highlights the successes in the research and development of COVID-19 treatments and vaccines that are already in use. In addition, there are a number of nanovaccines and nanomedicines currently in clinical trials that have the potential to target COVID-19.

Lungs Ultrasound in SARS-Cov-2 Diagnostics: a Prospective Comparative Study of 30 Patients with COVID-19 Pneumonia

INTRODUCTION. Lung ultrasound has been widely used to diagnose bacterial pneumonia, pulmonary congestion in heart failure, pneumo- and hydrothorax, and other pathological conditions. With the onset of the COVID-19 pandemic, the need for various methods of lung imaging has dramatically increased. AIM. To estimate the value of lung ultrasound in the diagnosis and severity assessment of COVID-19. MATERIAL AND METHODS. Patients with a positive PCR test result for SARS-Cov-2 were included and divided into a moderate, severe, or critical severe group. There were 30 patients involved. All the patients underwent clinical assessment, complete blood count, biochemical blood profile, pulse oxymetry, bedside lung ultrasound, and chest CT scan. To evaluate LUS findings thorax into 16 lung regions and each of these areas was quantitatively scored and summed up in total LUS score. A total severity score for chest CT was compared with the total LUS score. RESULT AND DISCUSSION. All patients had positive LUS findings, as well as positive CT findings. Most common lung ultrasound findings were the following: subpleural consolidations (100.0%, 30/30), large consolidations (73.3%, 22/30) and an irregular pleural line (43.3%, 13/30). A higher total lung ultrasound score was seen in patients with a more severe course of illness and a larger number of lung areas affected;they were older and had a significantly higher incidence of comorbidities and lower SpO2. Spearman correlation coefficient revealed a statistically significant correlation between CT chest scan and lung ultrasound – rs=.52, p= 0.003011. CONCLUSION. During the COVID-19 pandemic, lung ultrasound is a great tool for assessing lung tissue in patients with varying severity of the disease. The advantages of the method are accessibility, ease of implementation and the absence of radiation exposure. © 2022, Svetlana A. Rachina, Daria A. Strelkova, Flora E. Cabello Montoya, Olga T. Zorya, Ayten F. Safarova, Olga V. Aryutina, Stanislav K. Gruzdev, Vladimir V. Mladov.

Advance IoT Intelligent Healthcare System for Lung Disease Classification Using Ensemble Techniques

In healthcare systems, the Internet of Things (IoT) innovation and development approached new ways to evaluate patient data. A cloud-based platform tends to process data generated by IoT medical devices instead of high storage, and computational hardware. In this paper, an intelligent healthcare system has been proposed for the prediction and severity analysis of lung disease from chest computer tomography (CT) images of patients with pneumonia, Covid-19, tuberculosis (TB), and cancer. Firstly, the CT images are captured and transmitted to the fog node through IoT devices. In the fog node, the image gets modified into a convenient and efficient format for further processing. advanced encryption Standard (AES) algorithm serves a substantial role in IoT and fog nodes for preventing data from being accessed by other operating systems. Finally, the preprocessed image can be classified automatically in the cloud by using various transfer and ensemble learning models. Herein different pre-trained deep learning architectures (Inception-ResNet-v2, VGG-19, ResNet-50) used transfer learning is adopted for feature extraction. The softmax of heterogeneous base classifiers assists to make individual predictions. As a meta-classifier, the ensemble approach is employed to obtain final optimal results. Disease predicted image is consigned to the recurrent neural network with long short-term memory (RNN-LSTM) for severity analysis, and the patient is directed to seek therapy based on the outcome. The proposed method achieved 98.6% accuracy, 0.978 precision, 0.982 recalls, and 0.974 F1-score on five class classifications. The experimental findings reveal that the proposed framework assists medical experts with lung disease screening and provides a valuable second perspective. © 2023 CRL Publishing. All rights reserved.

Radiological findings of severe SARS-CoV-2 pneumonia: 1-year follow-up

Introduction: Patients who were affected by severe SARS-CoV2 pneumonia are now presenting respiratory sequelae. High resolution CT (HRCT) offers information about the evolution of the disease and its possible progression in form of pulmonary fibrosis. Aim(s): To assess the radiological findings during 1-year follow-up in patients affected by severe SARS-CoV-2 pneumonia, to determine the incidence of pulmonary fibrosis and its possible risk factors. Method(s): A prospective cohort study was conducted at Dr. Josep Trueta Hospital and Santa Caterina Hospital, including patients with severe SARS-CoV-2 pneumonia hospitalized at the Pulmonology service between March and June 2020. A 1-year follow-up was done, with controls in the 3rd and 6th months. We analysed clinical data, radiological findings, quality of life, grade of dyspnoea, pulmonary function testing and exercise capacity. Pulmonary fibrosis was defined by traction bronchiectasis/bronchiolectasis, pulmonary distortion or honeycomb pattern. Result(s): 94 patients were analysed. In a year span, 47.9% of HRCT were pathological, showing pulmonary fibrosis in 25.8% of them. Ground-glass opacities (GGO) were found in 66.5% of HRCT at the 3rd month, showing an improvement at the 6th month and a practical resolution at the 12th month. However, the fibrotic disease remained stable from the 6th month. The multivariant analysis showed a significant major incidence of pulmonary fibrosis among elderly patients. Conclusion(s): A practical resolution of the GGO is seen in most patients at the 6th month. Up to a quarter of patients develop fibrotic changes at the 1-year follow-up, however it remains stable from the 6th month onwards. Old age would be considered as a risk factor.

A New Chapter for Medical Image Generation: The Stable Diffusion Method

Data collecting and sharing have been widely accepted and adopted to improve the performance of deep learning models in almost every field. Nevertheless, in the medical field, sharing the data of patients can raise several critical issues, such as privacy and security or even legal issues. Synthetic medical images have been proposed to overcome such challenges;these synthetic images are generated by learning the distribution of realistic medical images but completely different from them so that they can be shared and used across different medical institutions. Currently, the diffusion model (DM) has gained lots of attention due to its potential to generate realistic and high-resolution images, particularly outperforming generative adversarial networks (GANs) in many applications. The DM defines state of the art for various computer vision tasks such as image inpainting, class-conditional image synthesis, and others. However, the diffusion model is time and power consumption due to its large size. Therefore, this paper proposes a lightweight DM to synthesize the medical image;we use computer tomography (CT) scans for SARS-CoV-2 (Covid-19) as the training dataset. Then we do extensive simulations to show the performance of the proposed diffusion model in medical image generation, and then we explain the key component of the model. © 2023 IEEE.

The outcome of pulmonary function tests and high-resolution computed tomography of chest in post-coronavirus disease 2019-confirmed cases after 3 months of recovery

Background: Coronavirus disease (COVID-19) is a recently prevalent infectious disease that is caused by a virus from the coronavirus family and causes acute respiratory syndrome. It is a pandemic catastrophe that has affected more than 60 million people around the world and has caused about 1.5 million deaths, as reported by the WHO. This disease affects the respiratory system and leads to different forms of symptoms and signs. Pneumonia is a common cause for hospitalization, with most patients treated in hospital wards and others requiring ICU. Although the number of complete recoveries from COVID-19 has increased, there is still concern about complications associated with the disease that appear after recovery. The studies that have looked at past types and other forms of coronavirus epidemics, such as SARS have shown that some cases had respiratory complications from the infection after being full recovered, as 36 and 30% of the entire study population had clinical and high-resolution computed tomography (HRCT) changes at 3 and 6 months after recovery, respectively. Mostly, the abnormalities seen in pulmonary function test (PFT) results are sequelae of diffusion capacity defect. In recovered cases of Middle East respiratory syndrome, 36% of patients showed HRCT sequelae at follow-up of 6 weeks, because of fibrosis. Data on COVID-19 indicate that prolonged disease and persistent symptoms show post-PFT affection and follow-up radiographic changes after recovery from COVID-19 as interstitial pulmonary changes and a degree of pulmonary vasculopathy. In recovered cases of COVID-19, capacity of diffusion is the commonest defect in lung function, followed by the restrictive pattern defects on spirometry;both are related to the degree of severity of pneumonic COVID-19. PFTs (involving spirometry as well as diffusion capacity) are considered as routine follow-up examinations for some of the recovered cases, especially severe cases. Rehabilitation programs of the respiratory system are an option strategy that might be considered. This study aims to show changes in pulmonary function and HRCT of chest in post-COVID-19-infected patients to detect long-term effects on the lungs after 3 months as obstructive or restrictive, or both, lung diseases. Patients and Methods: The study was conducted on 100 confirmed PCR-positive COVID-19 cases that were admitted to Ain Shams University Isolation Hospitals, and the follow-up was performed in the outpatient clinic. PCR samples (Combined nasopharyngeal and oropharyngeal swab) were taken after 3 months from discharge of patients above the age of 18 years who become negative with clinical improvement. PFT [spirometry and diffusion for carbon monoxide (DLCO)] and chest HRCT were done. All patients' clinical data were recorded, and CT chest imaging data of these patients were correlated with the clinical data. Result(s): A total of 100 patients were included in this study, where males represented 58% and female represented 42%. The mean+/-SD age of cases in this study was 45.05 +/- 11.80 years and ranged from 20 to 79 years. CT chest severity score (SS) of abnormality in COVID-19-infectedd patients based on HRCT chest findings before and after 3 months from treatment showed a highly significant correlation (P=0.000). The results of PFT in the studied group after 3 months of discharge showed restrictive pattern in 14.9%, obstructive pattern in 17.8%, and both obstructive and restrictive patterns in 5.9% of the total number of cases. There was a significant correlation between DLCO abnormality findings and age of studied group (P=0.032), a significant correlation between abnormality findings on PFT and HRCT chest SS after discharge of the studied group (P0.001). There was a significant correlation between abnormality findings of DLCO and HRCT chest SS after 3 months of the studied group (P=0.000) and before treatment (P=0.001), whereas there was no significant correlation between other findings of PFT and HRCT chest SS after 3 months and before. There was a significant correlation between H

Respiratory outcomes 3-month following COVID-19- related hospitalisation: a Tunisian prospective study

Background: Despite recovery from COVID-19,concern remains that some organs, including the lungs, might have long-term impairment following infection. Aim(s): Assess symptoms,pulmonary function,exercise capacity and chest HRCT changes in non-intubated patients hospitalised with severe COVID19 pneumonia at 3months. Method(s): In this prospective,longitudinal study,patients admitted to hospital for severe COVID19 who did not require mechanical ventilation were prospectively followed up at 3months after discharge from respiratory department Rabta Hospital of Tunis. During the follow-up,patients were interviewed and underwent pulmonary function tests(PFT),chest high-resolution CT(HRCT)and 6-min walk distance test(6MWT). PFT included:diffusing capacity of the lungs for carbon monoxide (DLCO);forced vital capacity(FVC);forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). Result(s): Between June 1st, and august 31, 2021;47 patients (mean age 56 +/- 12 years;sex ratio 0.74)were included. At 3 months, the most common persistent symptoms were dyspnea(78.7%),cough(46.8%),fatigue(36.2%) and anxiety(17%). Abnormal HRCT findings were pulmonary fibrosis (4%),ground glass opacities(42.5%) and consolidation(32%). Median FVC, FEV1 and TLC were respectively 97% (53-119%), 87.5% (30-120%) and 87% (72- 127%). DLCO was below the lower limit of normal in 12.7% of patients. During 6MWT, the average walked distance was 480 meters [120-680];22 patients (46.8%) showed reduced physical capacity. Conclusion(s): At 3 months after severe COVID pneumonia,a substantial number of patients still have respiratory symptoms with radiological and functional impairment. A long-term monitoring is mandatory.

Endovascular Treatment of Pulmonary Artery Pseudoaneurysms Post-COVID-19 Pneumonitis

Pulmonary artery pseudoaneurysms (PAPs) are uncommon entities consisting of contained rupture of the pulmonary artery and are a potentially fatal cause of hemoptysis. We describe two index cases of left lower lobe PAPs and arterial ectasia post-COVID-19 pneumonitis and their endovascular treatment with Amplatzer vascular plug, coils, and glue.Copyright © 2022. Indian Society of Vascular and Interventional Radiology. All rights reserved.

CXR severity as a predictor for post-COVID-19 related ILD

COVID-19 is caused by SARS COV-2, which first emerged in China and spread widely worldwide. Chest X-ray(CXR) is the first-line tool for COVID-19, and it allows initial assessment and follow-up, giving a great insight into the disease course. A high-resolution computed tomography (HRCT) has become essential for the diagnosis of postCOVID related interstitial lung disease (ILD). Our aim was to determine the COVID-19 disease severity using the CXR scoring system and then evaluate whether the severity of admission CXR could predict the presence of post-COVID related ILD. Data were analysed retrospectively for all adult patients presenting to our hospital between August 2020 and December 2021. 44 patients were found with post-COVID related ILD on HRCT which was performed as a result of persistent abnormalities on 6-12 week follow up CXR. We used severity scoring systems which were classified as mild, moderate, and severe depending on the number of lung segments involved. Severity scoring was performed by an experienced radiologist. Each CXR classification was then compared to HRCT findings. A total of 44 patients with COVID-19, 31 men and 13 women were included. The mean age was 67.7 (range 45-93). The following disease patterns were reported on HRCT: ground-glass opacities, traction bronchiectasis, reticulation, fibrosis, consolidation, organizing pneumonia, and honeycombing. When HRCTs were correlated, 18 admission CXRs were classified as mild, 23 as moderate and 3 as severe. This suggests that the severity of admission CXR does not predict the subsequent emergence of post-covid related ILD. We would recommend looking at other possible predictors such as the need for ventilatory support, comorbidities, and intensive care admissions.

Leser-Trelat sign: can it follow COVID-19 infection?

Seborrhoeic keratosis is a benign brownish-black skin lesion that is almost always seen in middle-aged and elderly populations. The sudden onset and rapid increase in size and/ or number of seborrhoeic keratoses is called the Leser-Trelat sign, suggesting a paraneoplastic manifestation of internal malignancy. However, eruptive seborrhoeic keratoses are also described in some nonmalignant conditions such as human papillomavirus infection and HIV infection. Herein, we report a case with Leser-Trelat sign in a patient following COVID-19 infection. A 50-year-old man presented to our dermatology clinic complaining of the sudden appearance of multiple warty-like lesions on his back, which had occurred 2 months after recovery from COVID-19 infection. According to his medical history, the patient presented with cough, fever and dyspnoea about 2 months prior to the appearance of his skin lesions. He was referred to a health centre, where a nasopharyngeal swab was taken, and his polymerase chain reaction test for COVID-19 was positive. In addition, bilateral patchy ground-glass infiltration was reported in his high-resolution computed tomography (HRCT) scan, all in favour of COVID- 19 infection. The patient was then treated with acetaminophen, dexamethasone (intramuscular injection), salmeterol and a fluticasone inhaler, and his symptoms improved. Two months after recovery from his mild COVID-19 infection, several small asymptomatic pigmented verrucous papules appeared on his back. Physical examination revealed multiple rough, oval-shaped, brownish papules of varying size. Dermatoscopy of the lesions was also performed. Both clinical and dermoscopic findings were in favour of seborrhoeic keratosis. In order to reach a final diagnosis, a skin biopsy was performed, and microscopic examination of the biopsy specimen showed hyperkeratosis and well-defined epidermal hyperplasia composed mainly of the proliferation of benignlooking basaloid cells and fewer squamoid cells and horn cysts and increased melanin, mostly at the dermoepidermal junction. The dermis showed no significant change. Based on the above findings, the patient was diagnosed with eruptive seborrhoeic keratosis. To determine the possible cause of this eruption, the patient was further evaluated. In his past medical history, he was generally healthy before his COVID-19 infection and had no history of comorbidities. The patient underwent a workup to rule out any internal malignancies. Laboratory tests revealed normal results and included a complete blood count, liver and kidney function tests, electrolytes, prostate-specific antigen and urine analysis. Gastrointestinal endoscopy and colonoscopy ruled out any gastrointestinal malignancy. Chest X-ray and HRCT revealed no malignant lesion. In addition, the patient's abdominopelvic sonography was normal. The patient had no family history of similar skin lesions and gave no history of any chronic inflammatory skin diseases or viral conditions. Therefore, the appearance of the Leser-Trelat sign after COVID- 19 infection was a possibility in this patient. The role of transforming growth factor-alpha and tumour necrosis-alpha in eruptive seborrhoeic keratoses, as well as in COVID-19 infection, can be a common area of interest to explore in the aetiology of this entity.

The ability of Lung High-Resolution Computed Tomography Severity Score to early identify COVID-19 patients who need respiratory support. A retrospective analysis of a monocentric Italian COVID-19 cohort

Objectives: to evaluate the relationship of a quantitative severity score (SS) of lung involvement, derived from nonenhanced Chest High-Resolution Computed Tomography (HRCT), with COVID-19 disease severity and the ability to early identify patients who need respiratory support with continuous positive airway pressure (CPAP) and/or noninvasive mechanical ventilation (NIMV) during follow-up. Method(s): We retrospectively evaluated a cohort of consecutive enrolled patients hospitalized for COVID-19 in an academic hospital in Rome during the first spread of SARS-CoV2 infection. All the enrolled patients underwent HRCT at admission and standardized evaluation of the SS. The study outcome was the need of CPAP and/or NIMV during follow-up. Result(s): We enrolled 39 patients with a median disease duration of 5 days. The median (25degree-75degree percentile) SS at baseline was 5 (2-7). We grouped patients according to tertile distribution of SS. Median pO2/FIO2 ratio progressively decreased from low SS group (SS 0-3) to high SS group, p 0.02. SS positively correlated with pneumonia prognostic scores SOFA (r=0.36, p 0.044) and MEWS (r = 0.33, p 0.038). The SS ROC AUC in predicting the need of respiratory support was 0.74 (95% CI, 0.58-0.90). Using 5 as Youden index cut-off, the sensitivity and specificity of SS were 0.83 and 0.59 respectively. Conclusion(s): The SS obtained from baseline lung CT is related to the clinical and laboratory severity of lung involvement in COVID-19 and with the impairment of gas exchange.

Lung Ultrasound as a tool for monitoring the interstitial changes in recently hospitalised patients with COVID-19 pneumonia -the COVIDLUS study

Introduction: Lung Ultrasound (LUS) can track interstitial changes of COVID-19 pneumonia (CP) in the acute phase. CT has been used to evaluate the development of lung fibrosis post CP but its use is associated with increased ionising radiation. Aims and Objectives: We conducted a prospective single-centre pilot to assess the utility and feasibility of using serial LUS in adult patients recovering from CP. We hypothesize that LUS may provide a safe and acceptable alternative to CT imaging for the outpatient follow-up of these patients. Method(s): 21 subjects provided consent on the day of hospital discharge (D0) and were followed up for 83 days. High-resolution CT was performed on Day 83 and correlated with LUS on Days 0/41/83. Serum Ferritin, LDH, CRP, D-Dimer (Days 0/41/83), Spirometry (Day 41/83) and Quality of Life measures (EQ-5D Day 41/83) were obtained. 3 clinicians reviewed and scored the LUS images independently;CT scoring was performed by 2 thoracic radiologists blinded to the LUS findings. Result(s): 19 subjects completed the study (10 males [52%];mean age: 52 years [range:37-74]). LUS scores were significantly lower at Days 83 and 41 compared to Day 0 (Mean = 1.5 [D83] / 2.8 [D41] / 10.9 [D0] p<0.0001). Ground glass change was the most common finding on CT at Day 83. Correlation between LUS with HRCT at Day 83 was weak (Pearson r2=0.44). However a better correlation was observed in % change of LUS scores and KCO at Day 84 compared to Day 42 (r2=0.64). Conclusion(s): LUS may be a useful point of care tool for the assessment of patients recently recovered from CP. However its role in the evaluation of post CP lung fibrosis requires further study.

Post Coronavirus Disease 2019 (COVID-19) pulmonary fibrosis: a 12 months follow-up study

Background: limited data exist on the prevalence of radiographic abnormalities after COVID-19 pneumonia, and the extent to which High Resolution CT (HRCT) features correlate with symptoms and function after 12-month from hospitalization remains unclear. Aim(s): To prospectively assess and characterize, among all discharged patients with COVID-19, those with persisting pulmonary sequalae after 12-month follow-up. Method(s): 354 patients were evaluated in our post-COVID-clinic from June 2020 to January 2021. Symptoms and functional parameters were recorded. According to the absence or presence of HRCT abnormalities after 12-months, patients were categorized as recovered (REC) or not recovered (NOT-REC) and the extension of radiographic changes was scored. Result(s): 296/354 patients(84%) completed the 12-month follow up. 21/296(7%) presented pulmonary sequelae with a mean extension of interstitial changes of 11% of the whole lung. REC displayed a median full recovery time of 131(60-203) days. Compared to REC, NOT-REC were mainly current smokers [3(14%) vs.12(4%);p=0.05], with a longer in-hospital stay [13 (7.5-40.5) vs.10.0(6.0-16.0);p=0.02], need for a higher maximal FiO2 during hospitalization [60(29-100) vs. 33 (21-65);p<0.004] and higher intensity medical care [10(48%) vs.48(17%);p<0.001]. Conversely, lung function did not differ [FVC 97%(88-109) vs.93(82-105),p=0.32;FEV1 102% (86-116) vs. 96(85-106);p=0.11]. Conclusion(s): A low percentage of patients discharged for COVID-19 pneumonia showed fibrotic-like changes at 12month follow-up, yet with preserved lung function. They are mainly current smokers, with a higher level of medical care during hospitalization and a prolonged in-hospital stay.

Pulmonary function and tomographic features in adult survivors of severe COVID-19 pneumonia: a prospective study of 12-month follow-up

Introduction: There is a lack of data on long-term sequelae of severe COVID-19 pneumonia beyond clinical followup at 6 months. Aim(s): To describe the evolution of pulmonary sequelae at 3, 6 and 12 months in severe COVID-19 survivors in terms of pulmonary function and high-resolution computed tomography (HRCT) of the chest. Method(s): 84 subjects (74% male, median age: 63 [49-70]) hospitalized for COVID-19 pneumonia (January 2021- January 2022) were evaluated at 3, 6 and 12 months after discharge with spirometry, lung diffusing capacity (DLCO), 6-minute walking test (6MWT) and HRCT. Result(s): At 3, 6 and 12 months, 64%, 70% and 80% of patients were found to have normal spirometry (FVC: 83+/-6%, 96+/-2%, 97+/-2%]);DLCO <80% was found in 66% (mean 77+/-1%), 63% (mean 74+/-2%) and 43% (mean 81+/-1%) of subjects;6MWT performance was normal in 70% (median 494 m [582-472]), 84% (median 552 m [487- 583]) and 100% (median 557 m [496-588]) of subjects. However, after 1 year of discharge, 50% of patients had persistent oxygen desaturation at the end of the 6MWT. HRCT abnormalities were detected at 3, 6 and 12 months in 87%, 60% and 43% of patients. The most prevalent HRCT patterns at 12 months were ground-glass opacities (71%), subpleural reticulation and atelectasis (35%) and bronchiectasis (10%). Conclusion(s): A high prevalence of persistent lung function and HRCT abnormalities was found in survivors of severe COVID-19 pneumonia. Evaluation at 3, 6 and 12 months showed progressively improving values of spirometry, DLCO and 6MWT over time. However, long-term HRCT anomalies and exercise-induced desaturation suggest persistent interstitial phenomena of unknown implications.