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Reaching a proper diagnosis for critically ill patients is like collecting pieces of puzzle and bed side lung ultrasound (LUS) becomes a crucial piece complementary to clinical and laboratory pieces. It is a bed side, real time tool for diagnosis of patients in ICU who are critical to be transferred to radiology unit especially in Covid-19 pandemic with risk of infection transmission. The aim was to evaluate the accuracy of lung ultrasound in assessment of critically ill patients admitted to Respiratory Intensive Care Unit (RICU), moreover to assess its diagnostic performance in different pulmonary diseases as compared to the gold standard approach accordingly. This observational prospective (cross sectional) study with a total 183 patients who met the inclusion criteria,were selected from patients admitted at the RICU;Chest Department, Zagazig University Hospitals, during the period from September 2019 to September 2021. LUS examination was performed to diagnose the different pulmonary diseases causing RF. All cases were examined by LUS on admission. From a total 183 patients, 111 patients 60.7% were males and 72 patients 39.3% were females, with a mean age of 56+/-12.77 years, 130 patients were breathing spontaneously received conservative management with O2 therapy, 32 patients needed NIV while 21 patients needed IMV with ETT. Exacerbated COPD was the most common disease finally diagnosed followed by bacterial pneumonia, exacerbated ILD, post Covid-19 fibrosis and pulmonary embolism in32, 29,27, 19 and 11 patients respectively with corresponding diagnostic accuracy of LUS 97.3%, AUC=0.943, 93.9% (AUC=0.922), 96.7%(AUC=0.920), 97.8%, AUC=0.895, and 97.8% respectively, while Covid-19 pneumonia was the final diagnosis in 8 patients with LUS diagnostic accuracy of 97.8% (AUC=0.869) with no statistical significant difference p-value=0.818 with bacterial pneumonia in distribution of US profiles. A profile was the commonest detected US profile among the studied patients followed by B profile, C profile, A/B profile and A' profile in 37.2%, 24.6%, 15.8% 4.9%, and 3.8% of cases respectively. Bed side LUS has a reliable, valuable diagnostic performance when integrated with clinical and laboratory data for the diagnosis of most pulmonary diseases in RICU.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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Cerebral venous thrombosis (CVT) is a form of cerebrovascular disorders that is difficult to recognize, it is potentially a life threatening condition and requires timely anticoagulant therapy. In the era of the COVID-19 pandemic, there is a steady increase in CVT (4.2% vs. 0.5-1%). At the same time, mortality in patients with CVT on the background of COVID-19 significantly exceeds the mortality in patients with CVT without COVID-19 (45.5% vs. 15%). Objective(s): to study the clinical course of CVT, to determine the diagnostic value of radiological methods and the significance of genetic risk factors for thrombosis in the development of CVT in young and middle-aged patients against the background of COVID-19. Material and methods. Seven patients were examined: six women (five of them of reproductive age) and one man, aged 26 to 57 years (mean age 37 years). The main clinical and neurological manifestations of CVT, the results of laboratory examination, neuroimaging, and the data of molecular genetic analysis of risk factors for thrombosis were analyzed. Results. The course of COVID-19 was severe in one case, and moderate in the rest of cases. The interval between the onset of COVID-19 symptoms and the development of CVT ranged from 7 to 25 days. In three cases CVT had an acute course and was accompanied by the development of a stroke (in two cases, hemorrhagic stroke was noted, in one case, multifocal ischemic stroke), in other cases, a subacute course of CVT was noted. Genetic risk factors for thrombosis were identified in all patients. Conclusion. The diagnosis of CVT in the era of the COVID-19 pandemic is particularly difficult, since the most common symptom of CVT - headache (90%) - can be regarded as a manifestation of COVID-19. At the same time, timely diagnosis of CVT and immediate initiation of anticoagulant therapy are associated with a relatively favorable prognosis.Copyright © 2023 Ima-Press Publishing House. All rights reserved.
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Backgrounds: This study aimed to analyze the applicability of platelet parameters in assessing the severity of COVID-19 disease. Material(s) and Method(s): Patients with RT-PCR confirmed COVID-19 in the Pathology department of a tertiary care hospital in south India from June to December 2020 were included in this study. Clinical details and laboratory parameters of these patients were obtained. The difference between the studied variables in two groups was assessed using independent t-test. The optimum cut-off value of platelet to lymphocyte ratio (PLR) to differentiate between the tested groups was estimated using ROC (receiver operator curve) analysis. Finding(s): This study was conducted on 218 COVID-19 patients, of whom 17.9% showed thrombocytopenia at the time of admission. Among the hematological parameters, PLR, absolute lymphocyte count (ALC), platelet distribution width (PDW), D-dimer, and erythrocyte sedimentation rate (ESR) were significantly different between the ICU (intensive care unit) and non-ICU groups. Increased PLR values were associated with the disease severity. Conclusion(s): PLR could be used as an additional biomarker in assessing the severity of COVID-19 disease, and a cut-off value of 210.27 is optimal to differentiate severe COVID-19 disease from its mild and moderate forms with 79% specificity.Copyright © 2023, TMU Press.
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Introduction: Lung cancer is third most common cancer and highest cause of cancer death in the UK. COPD and smoking are known cancer risk factors so early intervention is essential. Incidence is higher in areas of deprivation where early presentation is less likely and outcomes poorer. Middlesbrough has some of the highest areas of deprivation. Aim(s): To evaluate diagnostic value of CT screening pilot in detecting lung cancer and follow-up outcomes for patients with incidental finding of pulmonary nodules. Method(s): Between March 2019 - December 2022 17 GP practices in Middlesbrough were invited to offer non-contrast CT thorax to asymptomatic COPD patients eligible for review, aged 50-75 with 20 pack year history and QCancer risk >5%. Pulmonary nodules followed up as per BTS guidelines. This pilot was conducted in partnership and with support from the Northern Cancer Alliance. Result(s): 407 patients referred for CT, 312 met the criteria and enrolled. 5 (1.6% conversion rate) lung cancers, also 1 renal cancer diagnosed. 51 (17%) had features of pulmonary nodules or groundglass opacities and selected for follow up. 2 died from COVID infection before follow-up CT. 32 (62.8%) discharged after followup CT revealed stable appearances or resolution, follow-up CT still outstanding for 2. 4 (7.8%) selected for further follow-up of sub-solid, new or increasing nodules. 2 (3.9%) received radiological diagnosis of lung cancer and referred for radiotherapy, 1 underwent surgical resection revealing lung tumourlets and 1 referred for surgical resection of enlarging nodule. Conclusion(s): Pulmonary nodules consisted significant part of the CT screening pilot findings in COPD patients with significant further conversion rate to lung cancer diagnosis after follow-up. Therefore, CT screening of high-risk population in deprived areas has a role in detecting lung cancer and identifying pulmonary nodules, with a proportion of those later diagnosed as early lung cancer. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
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Purpose - to draw attention to an infection that was little known, but has now become a global problem for society;to familiarize readers with the peculiarities of the 2022 monkeypox outbreak and to increase the level of alertness of doctors to this disease. Monkeypox is a global problem because the disease is spreading rapidly, covering 111 countries. Three cases were diagnosed in Ukraine. It is predominantly a self-limited infection, but there are severe and deadly complications. The lethality of this disease ranges from 0% to 11%. The course of the disease is more severe in children and people with reduced immunity. Vertical transmission of the virus from mother to child is possible, resulting in congenital monkeypox. Monkeypox is a zoonotic disease and its natural reservoir is not exactly known, but rodents are most likely to act. In most cases, person-to-person transmission of the virus occurs through close skin to skin contact, often during sexual intercourse. At the beginning of the outbreak 98% of cases of disease were was diagnosed in homo- and bisexuals. Airborne transmission is also possible. Infection is possible through close contact with infectious skin lesions. Clinically, the initial period resembles influenza, but lymphadenopathy is characteristic, which is considered a pathognomonic symptom of mpox. The rash is similar to that of chickenpox, but with more prevalent location on palms and soles than in chickenpox. In the presence of a vesicular rash in a patient, it is necessary to exclude monkeypox. PCR diagnostics of the virus in samples of vesicles or crusts has the greatest diagnostic value. Hygienic skin care is important. Antiviral drugs (tecovirimat, brincidofovir) are recommended only in severe cases. To reduce the spread of infection, international rules apply as for other infections, such as COVID-19. The monkeypox virus vaccine is recommended primarily for groups at risk of infection, including medical personnel who may come into contact with the patient or samples for laboratory testing. Being aware for this infection, following international health regulations, it is possible to prevent the further spread of monkeypox.Copyright © 2023 Tomsk State University. All rights reserved.
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Background/Aims Giant cell arteritis (GCA) is the most common vasculitis in adults aged over 50 years old with the highest incidence among persons aged 70- 79. It is more commonly seen in female patients. Most cases have been reported in whites of Northern European descent. A broad range of symptoms can be reported including headache, jaw or tongue claudication, visual disturbances, PMR and other systemic features including weight loss, fever and sweats. In recent years new evidence has emerged regarding the investigation and treatment of GCA. This audit is to review the demographics, symptoms and investigations of patients who presented to the Rheumatology Department in SEHSCT with features concerning for possible GCA. Methods Retrospective collection of data from January 2020 to July 2021 using the regional Electronic Care Record NI with reference to presentations, investigation results, clinic records and follow-up letters. Results 70 patients were included (24 males and 46 females). Mean age was 72 years old. Table 1 shows the percentages of clinical symptoms reported. All patients investigated had an ESR (mean 57.8) and CRP (mean 54.1) checked. 43 patients had ANCA checked with 3 positive results. 40 patients underwent CT brain with 2 abnormalities reported unrelated to GCA. TA ultrasound was performed on one occasion with a positive result demonstrating ''halo'' sign recorded. 6 patients underwent CTPET with 3 diagnoses of LVV and 1 of PMR. 70 TAB performed with 12 positive results and 4 'suggestive' of GCA. Conclusion Our cohort of patients demonstrated demographics similar to the current global geographic trends in GCA. There are a broad range of clinical symptoms that can present in GCA, none of which are entirely specific or pathognomonic. Clinical diagnosis is based on clinical symptoms, signs and laboratory tests, each of which are imperfect markers for GCA. Our audit demonstrated that the use of additional confirmatory diagnostic tests including temporal artery ultrasound and CTPET was being under-utilized in the SEHSCT. Use of these tests may improve the diagnostic yield in this challenging condition. As a result of this audit, a quality improvement project to provide a rapid access GCA pathway is being designed. (Table Presented).
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Objective: To systematically evaluate the diagnostic value of nucleic acid test in sputum for COVID-19 and to determine the suitable population for sputum specimens. Method(s): PubMed, CNKI, Scopus, Web of Science, medRxiv and bioRxiv databases were searched for the diagnostic value of sputum nucleic acid test for COVID-19 from December 2019 to April 2022. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias with QUADAS-2 in the included studies. We used sensitivity, specificity, AUC and DOR to evaluate the diagnostic value of sputum specimens. Result(s): A total of 25 studies were included, including 10,731 subjects. Meta-analysis results showed that: The combined sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), and area under operating characteristic curve (AUC) of sputum nucleic acid for the diagnosis of COVID-19 were 89.2% (95% CI, 86.6-91.4), 97.5% (95% CI, 97.2-97.8), 41.4 (95% CI, 11.7-145.9), 0.9474 (95% CI, 0.8964-0.9846). The results of subgroup analysis showed that the Asian group's DOR was 36.835 (95% CI, 10.83-134.570), and the Non-Asian group's DOR was 66.294 (95% CI, 0.719-6109.09). The DOR was 27.207 (95% CI, 2.860-258.780) in the OPS group and 44.165 (95% CI, 4.828-403.970) in the NPS group. DOR of mild patients was 84.255 (95% CI, 9.975-711.690), the DOR of the severe group was 14.216 (95% CI, 3.527-57.142) and was 19.464 (95% CI, 0.724-522.920) in the cured group. Conclusion(s): Current evidence shows that sputum nucleic acid test is of high diagnostic value for COVID-19. Study area and severity of disease are the influencing factors for the diagnostic accuracy of the sputum nucleic acid test. Due to the limitations on the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.Copyright © 2023, E-Century Publishing Corporation. All rights reserved.
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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an important diagnostic procedure in the lung cancer pathway. False-negative or inadequate sampling can lead to inaccurate staging or delay in diagnosis. This study was conducted to assess the performance of the Cancer EBUS service at a tertiary hospital. Method(s): We conducted a retrospective analysis of patients who underwent EBUS-TBNA for suspected cancer between 1st June 2021 to 31st May 2022. Request forms, CT reports, EBUS reports and pathology reports were reviewed for analysis. Result(s): 205 EBUS-TBNA procedures were performed. All patients had an appropriate staging CT prior to procedure. The mean time to test was 10.5 days (7.4). 77 (38%) had tests within 7 days of request. 293 lymph nodes and 10 mass lesions were sampled. The mean time to pathological results being received was 2.9 days (1.8). Final histology showed 39 (19%) cases of lung adenocarcinomas, 3 (1%) lung non-small cell carcinomas, 25 (12%) lung squamous cell carcinomas, 25 (12%) small cell cancers, 4 (2%) lung NOS, 3 (1%) pulmonary carcinoid, 2 (1%) lymphoma, 12 (6%) other cancers, 12 granulomata and 1 thyroid tissue (6%). 43 (21%) cases showed lymphoid tissue and 28 (14%) were reported as inadequate. No samples were taken in 8 cases (4%). Adequate tissue for predictive marker testing was available in 93% (66) of cases of non-small cell lung cancer (NSCLC). Complications were encountered in 9 cases (4%). Only 3 cases (1.5%) required any form of intervention. [Figure presented] Conclusion(s): Our data provides assurance of safety while also highlighting specific areas for attention regarding performance and time to test that can be addressed and our sensitivity was comparable to national standards. The increased waiting times may be partly related to COVID-19 precautions and will require reauditing at a later date. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
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Objective: Coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome-coronavirus-2 continues across the world. Some patients with COVID-19 develop cytokine storm secondary to virally driven hyper-inflammation. This study aimed to assess the relationship of interleukin-6 (IL-6), procalsitonin (PCT) and C-reactive protein (CRP) levels with the severity of the disease in patients with COVID-19. Material(s) and Method(s): This retrospective study included 63 patients diagnosed with COVID-19 from January 2020 to March 2021. Data on demographic characteristics and clinical characteristics with the levels of IL-6, CRP, and PCT on admission were collected. ROC analysis was performed to determine whether interleukin-6 had a diagnostic value in predicting mortality. IL-6, CRP and procalcitonin values were evaluated by the Spearman correlation analysis. Result(s): In the ROC analysis performed in terms of predicting mortality, it was observed that IL-6 level predicted mortality at a statistically significant level (area under the curve: 0.708, p=0.004, 95% confidence interval: 0.583-0.833). A value of >358.3 pg/mL for IL-6 showed prognostic significance on mortality. In the Spearman correlation analysis performed between IL-6, CRP and procalcitonin values, a positive correlation was observed between CRP and procalcitonin (r=0.474, p=0.001). Conclusion(s): The serum levels of IL-6 and CRP can effectively assess disease severity in patients with COVID-19.Copyright © Telif Hakki 2022 Turk Immunoloji Dernegi. Turk Immunoloji Dergisi, Galenos Yayinevi tarafindan yayinlanmistir.
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Purposes: Artificial Intelligence (AI) models are constantly developing to help clinicians in challenging tasks such as classification of images in radiological practice. The aim of this work was to compare the diagnostic performance of an AI classifier model developed in our hospital with the results obtained from the radiologists reading the CT images in discriminating different types of viral pneumonia. Material(s) and Method(s): Chest CT images of 1028 patients with positive swab for SARS-CoV-2 (n=646) and other respiratory viruses (n=382) were segmented automatically for lung extraction and Radiomic Features (RF) of first (n=18) and second (n=120) order were extracted using PyRadiomics tools. RF, together with patient age and sex, were used to develop a Multi-Layer Perceptron classifier to discriminate images of patients with COVID-19 and non-COVID-19 viral pneumonia. The model was trained with 808 CT images performing a LASSO regression (Least Absolute Shrinkage and Selection Operator), a hyper-parameter tuning and a final 4-fold cross validation. The remaining 220 CT images (n=151 COVID-19, n=69 non-COVID-19) were used as independent validation (IV) dataset. Four readers (three radiologists with >10 years of experience and one radiology resident with 3 years of experience) were recruited to blindly evaluate the IV dataset using the 5-points scale CO-RADS score. CT images with CO-RADS >=3 were considered "COVID-19". The same images were classified as "COVID-19" or "non-COVID-19" by applying the AI model with a threshold on the predicted values of 0.5. Diagnostic accuracy, specificity, sensibility and F1 score were calculated for human readers and AI model. Result(s): The AI model was trained using 24 relevant features while the Area under ROC curve values after 4-fold cross validation and its application to the IV dataset were, respectively, 0.89 and 0.85. Interreader agreement in assigning CO-RADS class, analyzed with Fleiss' kappa with ordinal weighting, was good (k=0.68;IC95% 0.63-0.72) and diagnostic performance were then averaged among readers. Diagnostic accuracy, specificity, sensibility and F1 score resulted 78.6%, 78.3%, 78.8% and 78.5% for AI model and 77.7%, 65.6%, 83.3% and 72.0% for human readers. The difference between specificity and sensitivity observed in human readers could be related to the higher rate of false positive due to the higher incidence of COVID-19 patients in comparison with other types of viral pneumonitis during the last 2 years. Conclusion(s): A model based on RF and artificial intelligence provides comparable results with human readers in terms of diagnostic performance in a classification task.Copyright © 2023 Southern Society for Clinical Investigation.
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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.
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Purpose: Ventilation (V) perfusion (Q) SPECT imaging is important in the diagnostics of lung diseases such as pulmonary embolism, chronic obstructive pulmonary disease and recently in COVID-19 lung disease. The combined assessment of ventilation and perfusion permits the identification of classical mismatched and reverse mismatched defects, especially when these two parameters are combined in one measure as the ventilation perfusion ratio. Unfortunately, the ratio is only linear for ventilation and the scale is not symmetrical regarding classical and reversed mismatches. Small perfusion values give rise to artifacts. The scaled ventilation perfusion difference is presented as an alternative. Material(s) and Method(s): VQ SPECT was performed on patients with and without defects. Kr-81m was used as a ventilation tracer and MAA labelled with Tc-99m as a perfusion tracer. Ratio is defined as V/kQ and difference as V-kQ, where k is a scaling factor. The iterative z-map method was applied for determining the scaling factor for ratio and difference images yielding a ratio of one and zero difference for matched ventilation and perfusion. Clinical thresholds for both the difference images are derived resulting in color maps of relevant mismatches with an absolute ratio larger than the arbitrary value of two. Result(s): The relative difference is in second order proportional to the logarithm of the ratio, and has a scale going from -1 to +1, where -1 is perfusion only and +1 is ventilation only. Still the diagnostic value is hampered by the fact that areas with both low perfusion and ventilation can have high ratios. Therefore, the scaled (functional) difference is presented. Ratio, relative difference and scaled difference have been investigated in ten patients and are shown for three patients (one without defects). Ratio and relative difference images suffer from a visual overexposure effect as is clearly visible for the respiratory tract. One patient with an area in a bottom lung with a very low perfusion and slightly decreased ventilation demonstrated overflow problems of the intensity in ratio images and an overestimation of the mismatched area in both the ratio and relative difference images. Conclusion(s): While the relative ventilation perfusion-difference is a promising improvement of the ventilation-perfusion ratio, because it has a symmetrical scale and is bound on a closed domain, a better diagnostic value and functionality might be obtained by utilizing the scaled functional difference. The latter one seems superior to both the relative difference and ratio.Copyright © 2023 Southern Society for Clinical Investigation.
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Objective: Coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome-coronavirus-2 continues across the world. Some patients with COVID-19 develop cytokine storm secondary to virally driven hyper-inflammation. This study aimed to assess the relationship of interleukin-6 (IL-6), procalsitonin (PCT) and C-reactive protein (CRP) levels with the severity of the disease in patients with COVID-19. Material(s) and Method(s): This retrospective study included 63 patients diagnosed with COVID-19 from January 2020 to March 2021. Data on demographic characteristics and clinical characteristics with the levels of IL-6, CRP, and PCT on admission were collected. ROC analysis was performed to determine whether interleukin-6 had a diagnostic value in predicting mortality. IL-6, CRP and procalcitonin values were evaluated by the Spearman correlation analysis. Result(s): In the ROC analysis performed in terms of predicting mortality, it was observed that IL-6 level predicted mortality at a statistically significant level (area under the curve: 0.708, p=0.004, 95% confidence interval: 0.583-0.833). A value of >358.3 pg/mL for IL-6 showed prognostic significance on mortality. In the Spearman correlation analysis performed between IL-6, CRP and procalcitonin values, a positive correlation was observed between CRP and procalcitonin (r=0.474, p=0.001). Conclusion(s): The serum levels of IL-6 and CRP can effectively assess disease severity in patients with COVID-19.Copyright © Telif Hakki 2022 Turk Immunoloji Dernegi. Turk Immunoloji Dergisi, Galenos Yayinevi tarafindan yayinlanmistir.
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Introduction: Acute kidney injury (AKI) is a common complication of critical illness that often leads to increased mortality and morbidity. Biomarkers detect AKI earlier, providing a window of opportunity for timely intervention. Of the recent biomarkers in literature, the cell cycle arrest biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) were found to be superior in predicting AKI. Our study aims to evaluate the diagnostic performance of urine TIMP-2/IGFBP-7 in its ability of predict AKI and major adverse kidney events within 30 days (MAKE30) among high-risk patients for AKI. MAKE30 is a composite outcome comprised of all-cause mortality, use of renal replacement therapy (RRT), or persistent renal dysfunction at hospital discharge truncated at 30 days Methods: We conducted a prospective, cross-sectional study which included 135 adult, non-COVID ICU patients. Baseline urine TIMP-2/IGFBP-7 results were used to dichotomize the population into low risk (<0.3 ng/mL) or high risk (>=0.3 ng/mL) for AKI. Participants were then observed for 30 days and monitored for MAKE30 outcomes. ROC curves were created to calculate the sensitivity, specificity, NPV, PPV, and the AUC of the 0.3 ng/mL cut-off to predict the AKI and MAKE30. Result(s): Urine TIMP-2/IGFBP-7 cutoff of 0.3 ng/mL predicted AKI with a sensitivity 82.4%, specificity 79.2%, PPV 57.1%, NPV 93% and AUC 0.81. MAKE30 was detected with a sensitivity 62.8%, specificity 76.1%, PPV 55.1%, NPV 81.4% and AUC 0.69. Elevated levels of urine TIMP-2/IGFBP-7 were found to be associated with AKI (p<0.01), MAKE30 (p<0.01) and all of its subcomponents. Survival or discharge after 30 days were found to be associated with lower urine TIMP-2/IGFBP-7 levels (p<0.01). [Formula presented] Figure 1. Receiver operating characteristic (ROC) curves for predicting AKI across urine TIMP-2/IGFBP-7 levels [Formula presented] Figure 2. Receiver operating characteristic (ROC) curves for predicting MAKE30 across urine TIMP-2/IGFBP-7 levels Conclusion(s): Urine TIMP-2/IGFBP-7, at its current cut-off at 0.3 ng/mL, can predict the likelihood of developing AKI and major adverse kidney events among high-risk patients for AKI. It can serve as a useful adjunct to existing methods, such as serum creatinine, in the early diagnosis and prognosis of acute kidney injury and expanding the therapeutic window to prevent disease progression and improve outcomes. No conflict of interestCopyright © 2023
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A 56-year-old man admitted with coronavirus disease 2019 (COVID-19) became severely ill, required ventilator support and intensive care unit management. After ventilator weaning, he was found to have quadriparesis. Guillain-Barre syndrome (GBS) was suspected and administration of high-dose intravenous immunoglobulin (IVIg) was considered. However, markedly prolonged compound muscle action potential (CMAP) duration was observed, leading to a diagnosis of critical illness myopathy (CIM). Therefore, IVIg was not given at all, and supportive care was continued. A good functional recovery was obtained. Prolonged CMAP duration is a characteristic finding to CIM. CIM following severe COVID-19 infection is probably common, although the diagnostic value of prolonged CMAP duration is not widely recognized. This characteristic finding deserves more attention because it contributes to early differentiation between CIM and GBS and the use of IVIg in patients with COVID-19 may cause thrombotic complications and worsen the prognosis.Copyright © 2023 The Authors. Neurology and Clinical Neuroscience published by Japanese Society of Neurology and John Wiley & Sons Australia, Ltd.
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Objective: To explore the value of low-dose CT in pregnancy with COVID-19. Method(s): A retrospective analysis was performed on the clinical characteristics, laboratory tests, and chest CT findings of 12 pregnant women with COVID-19 diagnosed by nucleic acid testing in the Renmin Hospital of Wuhan University from January 20, 2020 to February 16, 2020. Two radiologists blinded to the reconstruction algorithm independently scored subjective image quality on a 5-point Likert scale. Image quality score >= 3 was acceptable in clinics. The CT radiation doses were recorded, including CT volume dose index (CTDIvol), dose length product (DLP), and effective radiation dose (E). Two radiologists observed the distribution, shape, density, and other characteristics of lung lesions, and they also decided whether hilar, mediastinal lymphadenopathy, and pleural changed. Result(s): A total of 12 pregnant women with COVID-19, 8 had cough, 4 had fever, 2 had chest tightness, and 1 had dyspnea and diarrhea each. The CT image quality score of all patients was 3-4, with an average of 3.46, which fully met the clinical diagnosis requirements. The CTDIvol value was 1.13-4.31 mGy, with an average of 3.02 mGy. The DLP value was 34.48-75.29 mGy*cm, with an average of 55.48 mGy*cm. The Evalue was 0.48-1.05 mSv, with an average of 0.78 mSv. In all cases, chest CT examination showed abnormal manifestations after clinical symptoms, including unilateral lung lesions in 5 cases and bilateral lung lesions in 7 cases, 1 case of ground-glass opacity, 1 case of solidification, 7 cases of ground-glass and consolidation, 1 case of strip opacity, ground-glass, and consolidation and strip cable shadow coexisted in 2 cases. Conclusion(s): The application of low-dose CT scan in pregnant women with COVID-19 is completely feasible. CT mainly manifested as bilateral lung patchy and flaky ground-glass opacity with consolidation. Active and effective treatment can help recover and improve prognosis.Copyright © 2020 by the Chinese Medical Association.
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Aim: This study was aimed at examining the role of hematological parameters among COVID-19 patients in Bihar. Method(s): The study was conducted at Bhagwan Mahavir Institute of medical science, pawapuri, Bihar, India for 7 months to compare hematological parameters of red blood cells (RBCs), platelets, and white blood cells (WBCs) among patients with and without COVID-19 diagnosis. In this study, 500 patients were recruited, a study group of 250 patients testing positive and a control group of 250 testing negative. Result(s): The result showed that 160 (64%) of COVID-19 patients were male and 90 (36%) were female, while 150 (60%) of non-COVID-19 patients were male and 100 (40%) were female. The age range of COVID-19 patients was 20-90 years old;150 of these (60%) between 30 and 60 years old, 75 (30%) over 60, and the remaining 25 (10%) below 30. The non-COVID-19 patients' age range was 20-88;150 of these (60%) between 30 and 60, 55 (22%) over 60, and the remaining 45 (18%) below 30. Regarding the clinical information of COVID-19 patients, 79 of them (31.6%) were attending the hospital in critical status, 54 (21.6%) with mild symptoms, 50 (20%) asymptomatic, 52 (20.8%) with moderate symptoms, and 25 (10%) with severe symptoms. Regarding the COVID-19 patients' situation during the study period, 175 (70%) recovered and were discharged from the hospital, 25 (10%) were still ICU patients at the end of the study period, 15 (6%) were isolated in hospital wards, and 35 (14%) unfortunately passed away. Conclusion(s): Our study results indicate that mild anemia associated with leukopenia may have diagnostic value for COVID-19. Careful assessment of hematological parameters, at baseline and throughout the disease path, will assist physicians in formulating personalized approaches to treatment and promptly offer intensive care to those in greater need.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Introduction: With the rapid spreading of the coronavirus (COVID-19) pandemic and the limited capacities of realtime reverse transcriptase-PCR (RT-PCR) at the laboratory level, there is an emerging need for rapid, point-of-care (POC), molecular testing in the Emergency Department (ED). Aims and objectives: To compare the diagnostic performance of ID NOW COVID-19 assay (Abbott, Chicago, Il, USA) performed by ED doctors with a gold standard reference RT-PCR test (GeneXpert assay developed by Cepheid). Method(s): Paired nasopharyngeal swabs were collected from consecutive adult patients suspected of having COVID-19 in the ED of a tertiary hospital in Athens (Greece);the first swab was directly used for the ID NOW COVID-19 assay in POC by an emergency physician and the second was analyzed with reference RT-PCR by a central laboratory technician. Cohen's kappa was run to determine if there was sufficient agreement between the two diagnostic methods. Result(s): Seventy one consecutive patients (36 female, mean age 64.6) were enrolled in the present study from 15th January to 21th February, 2022. The two tests agreed on 20 positive and 50 negative results. On the contrary, ID NOW COVID-19 assay was found positive in one patient with a negative reference RT-PCR test. There was very good agreement between the two diagnostic methods [kappa = 0.966 (95% CI, 0.900 to 1.032), p < 0.0001]. Conclusion(s): Comparison of a POC and a standard laboratory RT-PCR test in an ED patient population yielded high positive (95%) and negative percent agreement (100%). ID NOW COVID-19 assay seems to be a highly reliable POC test for early screening and triage of suspected COVID-19 patients.
ABSTRACT
Objectives: Considering the risk of aerosolization during the COVID-19 pandemic associated with transesophageal echocardiography (TEE), we evaluated the diagnostic performance of cardiac computed tomography (CCT) before pulmonary vein isolation (PVI) in comparison to semi-invasive TEE in excluding left atrial (LA)/LA appendage (LAA) thrombus, limiting the need for TEE to only patients with possible thrombus on CCT. Material(s) and Method(s): We included a total of 145 consecutive patients with atrial fibrillation (AF) (age 52.4 +/- 10.3 years;63% males;89 paroxysmal AF) referred for radiofrequency ablation in National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. All patients underwent preprocedural single-phase 128-slice multidetector CT and subsequent TEE as the reference standard with a mean time interval of 6.5 +/- 5.3 days between the two procedures. Result(s): CCT identified 30 patients (20.7%) with a filling defect in the LA/LAA, 8 of which were confirmed by TEE as thrombi (22 false positives and 8 true positives), whereas 9 true thrombi (6.2%) were detected by TEE (1 false negative by CCT). The sensitivity and specificity of CCT were 88.9% and 83.8%, respectively, with a positive predictive value of 26.8% and a negative predictive value of 99.1%. The overall accuracy was 84.1%. Conclusion(s): Apart from being a planned preparation modality before PVI, CCT is sufficient and could be used as an initial step to exclude the presence of LA/LAA thrombus, limiting the invasive TEE only for confirmation of the thrombus if detected by CCT.
ABSTRACT
Sepsis is a global health problem, annually over 45 million patients are diagnosed and over 11 million deaths are recorded. Activation of monocytes in sepsis by the pathogen agent or hypoxia brings about functional, morphological and phenotypic changes in these cells. Monocyte Distribution Width (MDW) is a new biomarker, defined as a measure of monocyte size heterogeneity and has been approved by the Food and Drug Administration for the early diagnosis of sepsis in the adult patient in the emergency department. In intensive care services, this biomarker can be used as a prognostic index in the follow-up of patients with sepsis. The indicator is a measure of the increased morphological variability of monocytes in response to infections, regardless of bacterial, viral or fungal etiology. This new marker also has increased values in the infection with COVID-19 and correlates positively with the severity of the disease.