Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.

Pleurisy and pericarditis as a cause of atypical chest pain in patients with in early post-COVID-19 period.

During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments. Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging. Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18-50 years old, 5-12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or post-inflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms. Results. 82 women and 118 men were included. Median of age 39 [28-46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditis in 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy - in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise - in 60% and a decrease in the quality of life - in 84%. Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early postCOVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain.Copyright © 2022 Infectious Diseases: News, Opinions, Training.

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).

A Review on the Effect of COVID-19 in Pregnant Women

Coronavirus Disease 2019 (COVID-19) is an emerging disease with a rapid increase in cases and deaths since its first discovery in December 2019, in Wuhan, China. Limited data are available on COVID-19 effects during pregnancy;however, information on diseases associated with other highly pathogenic coronaviruses (i.e. Severe Acute Respiratory Syndrome [SARS] and the Middle East respiratory syndrome [MERS]) may provide insight into the effects of COVID-19 during pregnancy. Coronaviruses cause illnesses ranging from the common cold to severe respiratory disease and death. The data indicate an average of 5 days incubation period (range: 2-14 days). The average age range of the hospitalized patients was 49-56 years, and a third to half of them have an underlying illness. Children were rarely mentioned. Within hospitalized cases, men were more frequent (54%-73%). Fever, cough, myalgia, vomiting, and diarrhea are common symptoms. This review aims at giving an in-depth understanding of COVID-19 by comparing its effects with SARS and MERS to evaluate its severity in pregnant women1. The results of varied studies show that COVID-19 affects pregnant women seriously and there is an alarming need to look into this aspect to prevent its harmful effects on the fetus.Copyright © 2020

Report of the Association Between Multisystem Inflammatory Syndrome and Severe Myocarditis

Introduction: The people worldwide have been affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection since its appearance in December, 2019. Kawasaki disease-like hyperinflammatory shock associated with SARS-CoV-2 infection in previously healthy children has been reported in the literature, which is now referred to as a multisystem inflammatory syndrome in children (MIS-C). Some aspects of MIS-C are similar to those of Kawasaki disease, toxic shock syndrome, secondary hemophagocytic syndrome, and macrophage activation syndrome. Case Presentation: This study reported an 11-year-old boy with MIS-C presented with periorbital and peripheral edema, abdominal pain, elevated liver enzymes, severe right pleural effusion, moderate ascites, and severe failure of right and left ventricles. Conclusion(s): Due to the increasing number of reported cases of critically ill patients afflicted with MIS-C and its life-threatening complications, it was recommended that further studies should be carried out in order to provide screening tests for myocardial dysfunction. Adopting a multidisciplinary approach was found inevitable.Copyright © 2023, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Radiological Features on HRCT Associated with Poor Outcomes among COVID-19 Patients

Background: Ever since the beginning of the COVID-19 pandemic, physicians started investigating the clinical features and lab markers that can assist in predicting the outcome among hospitalized COVID-19 patients. Aim(s): This study aimed to investigate the association between initial chest CT scan findings and adverse outcomes of COVID-19. Material(s) and Method(s): This was a single centre;hospital (inpatient) based prospective cohort study involving 497 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. We collected data about 14 identifiable parameters available for the HRCT scan. Result(s): Among 14 studied parameters, only 8 features differed significantly among the patients who had favourable and unfavourable outcomes. These features included number of lobes of lungs involved (3 versus 5, p = 0.008), CT Severity score (16 versus 20, p = 0.004), air bronchogram (p=0.003), crazy paving (p=0.029), consolidation (p=0.021), and pleural effusion (p=0.026). We observed that high CT scores coupled with the diffuse distribution of lung lesions were responsible for poor prognosis in most patients. Conclusion(s): Several features of HRCT when combined can accurately predict adverse outcomes among participants and help in triaging the patient for admission in ICU.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Late complications of the new coronavirus infection: a clinical case.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood. Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis. Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.Copyright © Chepurnenko S.A. et al., 2023.

The Compatibility of Chest CT Scan with RT-PCR in Suspected COVID-19 Patients

BACKGROUND: Thoracic computed tomography (CT) scan plays a role in detecting and assessing the progression of COVID-19. It can evaluate the response to the therapy given. In diagnosis, the CT scan of the chest may complement the limitations of reverse transcription polymerase chain reaction (RT-PCR). Several recent studies have discussed the importance of CT scans in COVID-19 patients with false-negative RT-PCR results. The sensitivity of chest CT scan in the diagnosis of COVID-19 is reportedly around 98%. AIM: This study aimed to determine the compatibility of CT scan of the thorax with RT-PCR in suspected COVID-19 patients. MATERIALS AND METHODS: This research was conducted in the Radiology Department of the Wahidin Sudirohusodo Hospital Makassar from April to December 2020 with 350 patients. The method used was a 2 x 2 table diagnostic test. RESULT(S): The study included 188 male patients (53.7%) and 162 female patients (46.2%). The most common age group was 46-65 years (35.4%). The most common types of lesions were ground-glass opacity (163 cases), consolidation (128 cases), and fibrosis (124 cases), mostly found in the inferior lobe with a predominantly peripheral or subpleural distribution. The sensitivity of the CT scan to the PCR examination was 86%, and the specificity was 91%. CONCLUSION(S): Thoracic CT scan was a good modality in establishing the diagnosis of COVID-19. CT scan of the chest with abnormalities could confirm the diagnosis in 88% of cases based on RT-PCR examination. It excluded the diagnosis in 91% based on the RT-PCR examination. The accuracy of the thoracic CT scan was 88% with RT-PCR as the reference value.Copyright © 2023 Sri Asriyani, Albert Alexander Alfonso, Mirna Muis, Andi Alfian Zainuddin, Irawaty Djaharuddin, Muhammad Ilyas.

Pulmonary sarcoidosis

The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.

Incidental tomographic findings in patients with a Confirmed Diagnosis of COVID-19: An Observational Study

Objective: Describe incidental tomographic in the sample, correlating them with risk factors for chest diseases and sociodemographic data. Method(s): This is a retrospective and observational study covering 162 patients admitted to the COVID sector of the HU/UFJF, from April 1, 2020, to July 7, 2021, with a confirmed laboratory diagnosis of COVID-19. The variables were described in absolute and relative frequencies. The comparison of the correlation between the outcome variable (the tomographic findings) for independent samples was performed using Pearson's chi-square test (without correction) or Fisher's test when relevant. Result(s): Of the 162 patients, 15.4% had a solitary pulmonary nodule;14.8% had multiple pulmonary nodules;1.8%, lung mass;3.1%, mediastinal mass, and 9.3% had mediastinal adenomegaly. Findings such as excavations, pleural effusion, emphysema, PTE, pneumothorax, chronic interstitial disease, cavitation, aneurysms, and significant atheromatosis, classified in this study in the "Other" category showed impressive results, with an overall prevalence of 81.5%. This study demonstrated that 34% of patients had two or more types of incidental CT findings and that 88.3% of patients had at least some type of incidental CT finding. Conclusion(s): The pandemic of SARS-CoV-2 infections has brought a series of challenges and lessons learned to healthcare teams around the world. The massive implementation of highly sensitive diagnostic methods, such as chest tomography, ends up bringing an additional challenge, which is to deal with incidental findings, making good clinical reasoning necessary to avoid unnecessary investigations and not leave without diagnosis and treatment of diseases in early and asymptomatic stages.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Late complications of the new coronavirus infection: a clinical case.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood. Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis. Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.Copyright © Chepurnenko S.A. et al., 2023.

Discovering associations between radiological features and COVID-19 patients' deterioration

Background and Aims: Data mining methods are effective and well-known tools for developing predictive models and extracting useful information from various data of patients. The present study aimed to predict the severity of patients with COVID-19 by applying the rule mining method using characteristics of medical images. Method(s): This retrospective study has analyzed the radiological data from 104 COVID-19 hospitalized patients diagnosed with COVID-19 in a hospital in Iran. A data set containing 75 binary features was generated. Apriori method is utilized for association rule mining on this data set. Only rules with confidence equal to one were generated. The performance of rules is calculated by support, coverage, and lift indexes. Result(s): Ten rules were extracted with only X-ray-related features on cases referred to ICU. The Support and Coverage index of all of these rules was 0.087, and the Lift index of them was 1.58. Thirteen rules were extracted from only CT scan-related features on cases referred to ICU. The CXR_Pleural effusion feature has appeared in all the rules. The CXR_Left upper zone feature appears in 9 rules out of 10. The Support and Coverage index of all rules was 0.15, and the Lift index of all rules was 1.63. the CT_Adjacent pleura thickening feature has appeared in all rules, and the CT_Right middle lobe appeared in 9 rules out of 13. Conclusion(s): This study could reveal the application and efficacy of CXR and CT scan imaging modalities in predicting ICU admission to a major COVID-19 infection via data mining methods. The findings of this study could help data scientists, radiologists, and clinicians in the future development and implementation of these methods in similar conditions and timely and appropriately save patients from adverse disease outcomes.Copyright © 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.

Drug-induced pericarditis

Though not common, drug-induced pericarditis is a serious condition, since pericardial tamponade, should it develop, may be life-threatening. As the number of drugs is constantly expanding, so does the proportion of those capable of causing pericarditis. The authors reviewed the relevant literature in the PubMed database and complemented it with information from the VigiBase database. In their article, the authors present current knowledge about the mechanisms of origin and level of risk of drug-induced pericarditis and discuss relevant information on individual drugs divided into 7 classes. Some medicines are associated with a high risk of developing pericarditis, a fact to be taken into account when treating patients with these agents. © 2022 Czech Society of Cardiology Z.S. All rights reserved.

Advances in molecular diagnostic tests for community-acquired pneumonia

The use of a timely and appropriate antibiotic therapy, which requires early and accurate microorganisms' detection in pneumonia. Currently, the identification of microorganisms in pneumonia is limited by the low sensitivity and long response time of standard culture-based diagnostic tools. For this reason, treatment in pneumonia is empirical. An inadequate empirical treatment is related to poor outcomes in patients with pneumonia. The microbiological diagnosis is key to improve the outcomes in patient with pneumonia. Over the past years there was a significant advance in the molecular diagnosis of infectious diseases including pneumonia. Also the impact of the COVID-19 pandemic has impacted the development and application of these new molecular techniques. This review summarizes the advances in molecular diagnosis of community-acquired pneumonia.Copyright © 2022 EDIZIONI MINERVA MEDICA.

A CASE OF SEVERE COVID-19 WITH PERSISTENT MASSIVE DIARRHEA.

A 63-year-old man was admitted to our hospital with sore throat and fever. He was diagnosed with Coronavirus Disease 2019(COVID-19), and on the 3rd day after diagnosis, he started on ventilatory management. On the 25th day, the patient presented with over 3 L of watery diarrhea, which continued daily. When the diarrhea did not improve with various treatments, on the 98th day, a double-balloon endoscopy of the small intestine was performed, and diffuse loss of villi structure in the jejunum was noted. Due to massive pleural effusion, the patient succumbed to circulatory and respiratory failure 111 days after admission to the hospital. The pathological autopsy revealed that the mucosal epithelium had been exfoliated from the entire small intestine. As this case shows, some COVID-19 cases are associated with severe diarrhea;further investigation is needed to elucidate the pathogenesis of COVID-19-associated diarrhea.Copyright © 2023 Authors. All rights reserved.

Comparison between suspected and confirmed COVID-19 respiratory patients: a pilot study

Introduction: The spread of COVID-19 imposed a re-organization of healthcare services. The increased circulation of the virus among the population and the need for a quick diagnosis suggest the identification of new decisionmaking actions. Aim(s): We aimed to determine whether clinical, laboratory and imaging characteristics can reliably differentiate suspected COVID from positives tested with nasal-pharyngeal(N-P)swab. Method(s): This is a retrospective, cross-sectional study on data collected(March-May 2020)at the Lung Unit, University of Pavia(confirmed cases=50)and at the Emergency Unit, University of Palermo(suspected cases=103). COVID-19 was confirmed by positive N-P swab. Suspected were tested negative. We recorded clinical, laboratory and radiological variables and compared them by Chi-squared or t-test. Logistic regression estimated which variables increased the risk of COVID-19 in both groups. A prediction model and derived ROC-AUCcurve, assessed the accuracy. P<0.05 was considered significant. Result(s): High ReactiveC-Protein, suggestive CTimages, dyspnea and respiratory failure increased the risk of COVID-19, whereas pleural effusion decreased the risk(table). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19(AUC 0.91). Conclusion(s): Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently of the N-P swab result. We suggest the inclusion of these elements in the decision-making to facilitate the management of suspected COVID.

Clinical Profile, Immunosuppressive Managment and Outcome in Adult Renal Allograft Recipients with Covid-19 Infection: A Case Series from Single Centre in Bangladesh

Introduction: The Novel Coronavirus disease 2019 (COVID-19), a respiratory infection has become a global concern. Given to the extent of the COVID-19 pandemic, it has been explored that Renal Allograft Recipients are considered high risk group for unfavourable outcome due to multiple comorbidities, long term immunosuppressive medications and residual CKD. This case series demonstrates clinical characteristics and outcome of COVID-19 infection in Renal Allograft Recipients. Method(s): Here we present 20 adult Renal Allograft Recipients admitted with moderate to severe symptom and RT PCR confirmed COVID-19 infection at united hospital limited from August 2020 to December 2021. We assessed demographic characteristics, comorbidities, clinical and laboratory parameters, radiological findings, immunosuppressive management and outcome. Result(s): Among all,15 patients were male with median age 55 years (range,34-75years). Mean time interval between renal transplantation were 90 months (24-132 months). Common comorbidities were hypertension (n=19), DM (n=18), lung diseases (n=13), IHD (n=9). Fever (100%) was most common symptom followed by cough(80%), sore throat(75%), and diarrhoea(60%). Nine (45%) patients who presented with dyspnoea during admission further progressed to poor outcome. During admission mean baseline creatinine was 1.51mg/dl(0.66-3.1 mg/dl), 15 patients had lymphopenia and 11 patients had higher inflammatory markers like high ferritin level, CRP, procalcitonin, LDH and D-dimer. Total 15 patients had abnormal HRCT findings and most common finding was unilateral or bilateral Ground glass opacity followed by consolidation, pleural effusion and interlobular septal thickening with mean TSS scoring being 8 (range 4-16). All patients were on triple immunosuppressive regimen (antimetabolites, CNI, low dose steroid).After admission antimetabolites were withdrawn in all patients, CNI were continued in 10 patients, 50% reduction in 2 patients, complete cessation of CNI in 8 patients and low dose steroids were switched to dexamethasone 6mg/ day. Other treatments included antiviral (Favipiravir, Remdisivir), antibiotics, LMWH followed by Rivaroxaban. Total 3 patients received Tocilizumab and Convalescent plasma was administered in 2 patients. Among all, 18 patients received different form of oxygen therapy, 9 patients were transferred to ICU, 7 patients required mechanical ventilation and 4 patients developed ARDS. 8 patients had other bacterial or fungal coinfection. six patients developed AKI and 2 of them needed Renal replacement therapy (RRT). Total 4 patients of AKI and 1 patient who required RRT finally expired. Total 6 patients died and after a median 18 days of admission. Conclusion(s): In this case series we describe 30% mortality rate. Older age, severe symptom specially dyspnoea during presentation, multiple comorbidities, high inflammatory markers, high baseline creatinine developing AKI, high TSS score at HRCT and requirement of mechanical ventilation were associated with high risk of death. No conflict of interestCopyright © 2023

Has the impact of the COVID-19 pandemic on uptake andusage of indwelling pleural catheters reduced its cost-effectiveness?

During the COVID pandemic, the British Thoracic Society recommended first-line indwelling pleural catheter (IPC)insertion or therapeutic aspiration for malignant pleural effusion (MPE) instead of admission for chest drain and talcpleurodesis to minimise hospital visits. This study aimed to review the uptake and usage of IPCs during and followingthe pandemic and its potential cost-effectiveness.Retrospective data analysis of IPCs between 2020-2021 was performed. Data collection included patient sex, age,WHO performance status (PS), indication and duration of IPC.187 IPCs were inserted;91% for MPE. 75% elected for IPC as first-line. 57% patients were PS 0-1 and 77% werePS 0-2. In 2020, 30% patients were self-draining compared to 12% in 2021. Mean duration IPC in-situ was 87 days(median 68 days). The pandemic saw increased use of first-line IPCs (75% 2020 vs 52% 2019) particularly in patients with good PS. This reduced initial hospitalisation (4.08 bed days) with an estimated cost saving of 1200 (300/day) per patient. Self-drainage rates also increased from 13% (2019) to 30% (2020) but have returned to pre-pandemic levels of selfdrainage at 12% in 2021 with need for district nurse visits for up to 3 months. Current practice of widespread first-line IPC use in the COVID endemic era may not be cost-effective and needs to be reviewed alongside the pre-existing evidence base.

A contrasting diagnosis: iododerma

An 86-year-old woman presented to the emergency department with acute shortness of breath. She was treated with intravenous furosemide for acute-on-chronic heart failure. Her past medical history included atrial fibrillation, hypertension, diverticulosis and hypothyroidism. Rivaroxaban and levothyroxine were her only long-term medications. On day 5 of hospital admission, she developed painful haemorrhagic and purulent bullae on her dorsal hands, head and neck. These evolved to large suppurative, vegetative plaques over a 72 h period and she developed additional lesions on her trunk, upper back and thighs. The patient had routine blood tests, which showed a raised C-reactive protein at 260 mg L-1, and an acute kidney injury with a glomerular filtration rate of 54 mL-1 min-1. She had a negative COVID-19 swab, and swabs from the lesions for bacterial culture and viral polymerase chain reaction were negative. She had a normal serum protein electrophoresis, immunoglobulin, antinuclear antibody and antineutrophil cytoplasmic antibody. She had computed tomography of her chest 24 h prior to the onset of her lesions, which showed mild bilateral pleural effusions in keeping with fluid overload secondary to heart failure. A biopsy taken from her hand showed orthokeratosis and parakeratosis, and there was bulla formation subepidermally. There was a dense neutrophilic infiltrate with microabscess formation with scattered eosinophils and lymphocytes. There was no evidence of vasculitis. Direct immunofluorescence was negative and a tissue culture for atypical mycobacteria was negative. The patient was commenced on high-dose intravenous methylprednisolone at 500 mg for 3 days followed by 40 mg prednisolone orally for 1 week, but there was a limited response. Our initial differential was Sweet syndrome or pyoderma vegetans;however, the patient had no fevers and no risk factors (malignancy, inflammatory disease, infection, etc.). She also had no response to high-dose oral prednisolone. Given the timing of her CT examination in relation to her acute dermatosis and the use of radioiodine for contrast, we assessed the patient's serum iodine and urine iodine. These were both high at 1.02 mmol L-1 (reference interval 0.32- 0.63) and 3.46 mmol L-1 (reference interval 0.0-2.43), respectively. A diagnosis of iododerma was made. The patient's eruption slowly resolved and at 12 weeks there was evidence of postinflammatory skin changes only. Her urine and serum iodine were rechecked, and both had normalized. In the last 20 years there have been approximately 20 case reports of iododerma. Most have been following iodine contrast use in patients with abnormal kidney function, like our patient. Most describe an acneiform eruption that subsequently evolves to vegetative plaques (Chalela JG, Aguilar L. Iododerma from contrast material. N Engl J Med 2016;374: 2477). Iododerma is largely a diagnosis of exclusion, but histopathology and urine and serum iodine levels can help support diagnosis.

Lung ultrasound for detection of pneumonic changes in patients with COVID-19 infection

This study aims to determine the suitability of lung ultrasound as an alternative to CT chest to aid in the initial management of these patients. The aim was to determine the value of lung ultrasound in the diagnosis of lung parenchymal affection in patients with COVID-19. Patients and Methods: A prospective including 150 patients was carried out in the Chest, Interventional Radiology and Clinical Pathology Departments in Bab-El-Sha'aria and Al-Hussin Hospitals, Al-Azhar University, during the period from May 2020 to September 2020. Lung ultrasound was performed in 150 patients with COVID-19 pneumonia diagnosed based on the integrated clinical, laboratory, and CT chest radiological data. Result(s): Among 150 patients, there were 86 males and 64 males, ranging in age from 30 to 75 years and a mean age of 55.8+/-12.1 years. Bilateral lung infiltrates in the CT scan were present in 146 patients (97.3%), CXR infiltrates were present in 63 patients (42%), sonographic evidence of pleuropulmonary involvement was present in 139 patients (92.7%), B lines and pleural line thickening were present in all patients with ultrasound findings (100%), subpleural consolidation associated with B lines was present only in 33 patients (23.7%) and pleural effusion was absent in all cases;crackles were only present in 53 (35.3%) patients. Conclusion(s): Because of its simplicity in interpretation, bedside availability, lack of risk of radiation and good sensitivity in the detection of lung parenchymal affection, the chest ultrasound is a useful tool in the management of patients with symptoms suspicious of COVID-19 infection and seems to be a suitable substitute for the CT chest in such circumstances.