COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Efficacy and safety of intravenous imatinib in COVID-19 ARDS: a randomized, double-blind, placebo-controlled clinical trial.

PURPOSE: A hallmark of acute respiratory distress syndrome (ARDS) is hypoxaemic respiratory failure due to pulmonary vascular hyperpermeability. The tyrosine kinase inhibitor imatinib reversed pulmonary capillary leak in preclinical studies and improved clinical outcomes in hospitalized COVID-19 patients. We investigated the effect of intravenous (IV) imatinib on pulmonary edema in COVID-19 ARDS. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled trial. Invasively ventilated patients with moderate-to-severe COVID-19 ARDS were randomized to 200 mg IV imatinib or placebo twice daily for a maximum of seven days. The primary outcome was the change in extravascular lung water index (∆EVLWi) between days 1 and 4. Secondary outcomes included safety, duration of invasive ventilation, ventilator-free days (VFD) and 28-day mortality. Posthoc analyses were performed in previously identified biological subphenotypes. RESULTS: 66 patients were randomized to imatinib (n = 33) or placebo (n = 33). There was no difference in ∆EVLWi between the groups (0.19 ml/kg, 95% CI - 3.16 to 2.77, p = 0.89). Imatinib treatment did not affect duration of invasive ventilation (p = 0.29), VFD (p = 0.29) or 28-day mortality (p = 0.79). IV imatinib was well-tolerated and appeared safe. In a subgroup of patients characterized by high IL-6, TNFR1 and SP-D levels (n = 20), imatinib significantly decreased EVLWi per treatment day (- 1.17 ml/kg, 95% CI - 1.87 to - 0.44). CONCLUSIONS: IV imatinib did not reduce pulmonary edema or improve clinical outcomes in invasively ventilated COVID-19 patients. While this trial does not support the use of imatinib in the general COVID-19 ARDS population, imatinib reduced pulmonary edema in a subgroup of patients, underscoring the potential value of predictive enrichment in ARDS trials. Trial registration NCT04794088 , registered 11 March 2021. European Clinical Trials Database (EudraCT number: 2020-005447-23).

Comparison of artificial intelligence versus real-time physician assessment of pulmonary edema with lung ultrasound.

BACKGROUND: Lung ultrasound can evaluate for pulmonary edema, but data suggest moderate inter-rater reliability among users. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of B line interpretation. Early data suggest a benefit among more novice users, but data are limited among average residency-trained physicians. The objective of this study was to compare the accuracy of AI versus real-time physician assessment for B lines. METHODS: This was a prospective, observational study of adult Emergency Department patients presenting with suspected pulmonary edema. We excluded patients with active COVID-19 or interstitial lung disease. A physician performed thoracic ultrasound using the 12-zone technique. The physician recorded a video clip in each zone and provided an interpretation of positive (≥3 B lines or a wide, dense B line) or negative (<3 B lines and the absence of a wide, dense B line) for pulmonary edema based upon the real-time assessment. A research assistant then utilized the AI program to analyze the same saved clip to determine if it was positive versus negative for pulmonary edema. The physician sonographer was blinded to this assessment. The video clips were then reviewed independently by two expert physician sonographers (ultrasound leaders with >10,000 prior ultrasound image reviews) who were blinded to the AI and initial determinations. The experts reviewed all discordant values and reached consensus on whether the field (i.e., the area of lung between two adjacent ribs) was positive or negative using the same criteria as defined above, which served as the gold standard. RESULTS: 71 patients were included in the study (56.3% female; mean BMI: 33.4 [95% CI 30.6-36.2]), with 88.3% (752/852) of lung fields being of adequate quality for assessment. Overall, 36.1% of lung fields were positive for pulmonary edema. The physician was 96.7% (95% CI 93.8%-98.5%) sensitive and 79.1% (95% CI 75.1%-82.6%) specific. The AI software was 95.6% (95% CI 92.4%-97.7%) sensitive and 64.1% (95% CI 59.8%-68.5%) specific. CONCLUSION: Both the physician and AI software were highly sensitive, though the physician was more specific. Future research should identify which factors are associated with increased diagnostic accuracy.

Evaluation of Efficacy of the Amino Acid-Peptide Complex Administered Intragastrically to Golden Hamsters Experimentally Infected with Sars-Cov-2

The development of coronavirus infection outbreak into a pandemic, coupled with the lack of effective COVID-19 therapies, is a challenge for the entire pharmaceutical industry. This study aimed to assess the treatment and preventive efficacy of the amino acid-peptide complex (APC) in male Syrian hamsters infected with SARSCoV-2 (intranasal administration of 26 mul of the virus culture, titer of 4 x 104 TCD50/ml). In a modeled COVID-19 case, APC administered for treatment and preventive purposes reduced lung damage. Compared to the positive control group, test group had the lung weight factor 15.2% smaller (trend), which indicates a less pronounced edema. Microscopic examination revealed no alveolar edema, atypical hypertrophied forms of type II alveolocytes, pulmonary parenchyma fibrinization. The macrophage reaction intensified, which is probably a result of the APC-induced activation of regenerative processes in the lung tissues. Spleens of the animals that received APC for therapeutic and preventive purposes were less engorged and had fewer hemorrhages. The decrease of body weight of the test animals that received APC for treatment and prevention was insignificant (p < 0.05), which indicates a less severe course of COVID-19. Administered following a purely therapeutic protocol, APC proved ineffective against SARS-CoV-2 post-infection. Thus, APC-based drug used as a therapeutic and preventive agent reduces pulmonary edema and makes morphological signs of lung tissue damage less pronounced in male Syrian hamsters infected with SARS-CoV-2.Copyright © Extreme Medicine.All right reserved.

COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

A Case of Abscessed Pneumonia Due to Covid-19 Infection in a Young Patient

Viral infections are the first ranked conditions among infectious diseases causing 5-15% of all community-acquired pneumonia. The aim of the study was to describe a case of COVID-19 infection, proceeding with acquired bacterial infection and developing abscess pneumonia in a young patient. Material and methods. The accompanying medical documentation was examined, clinical and morphological analysis was carried out for assessing macro- and micropreparations. Results. Patient A.E., 31 years old, within 5 hours 10 minutes was at in-hospital treatment with a diagnosis of Coronavirus infection, severe course. Community-acquired bilateral polysegmental pneumonia. The patient admitted with complaints of respiratory difficulty, shortness of breath, weakness, fever up to febrile level, severe pain in the right groin area, both lower extremities, swelling in hands and feet. However, despite initiated treatment, the patient's condition worsened and biological death was verified. The postmortem examination revealed signs of total bilateral hemorrhagic pneumonia. Histological examination showed areas of necrosis in the alveolar epithelium and signs of marked edema with a hemorrhagic component;hemolyzed erythrocytes were found in alveolar lumen. Focal hemorrhages were visualized in the pulmonary parenchyma, sometimes merging along with lung tissue with forming microabscesses. a well-defined shaft consisting of granular leukocytes and congested vessels with erythrocyte sludge was noted on the periphery of necrosis area. In the alveoli located closer to the abscesses, fibrinous and serous exudate was detected. Signs of edema were observed in the brain;histological examination revealed perivascular, pericellular optical voids with vascular congestion, erythrocyte sludge and minor hemorrhages. SARS-CoV-2- caused pneumonia and acquired bacterial infection, in this case due to staphylococcus, led to abscess pneumonia and severe respiratory failure with developing acute distress syndrome. Obviously, the high frequency of destructive processes in staphylococcal pneumonia is due to the pathogenic staphylococci characterized by production of high-level proteolytic enzymes destroying body tissues. Thus, the current case of COVID-19 infection in a young patient is of particular importance and relevance, because it demonstrates an unfavorable disease outcome despite patient young age and lack of concomitant pathology.

Diagnosis of Pulmonary Edema and Covid-19 from CT slices using Squirrel Search Algorithm, Support Vector Machine and Back Propagation Neural Network

A Computer Aided Diagnosis (CAD) framework to diagnose Pulmonary Edema (PE) and covid-19 from the chest Computed Tomography (CT) slices were developed and implemented in this work. The lung tissues have been segmented using Otsu's thresholding method. The Regions of Interest (ROI) considered in this work were edema lesions and covid-19 lesions. For each ROI, the edema lesions and covid-19 lesions were elucidated by an expert radiologist, followed by texture and shape extraction. The extracted features were stored as feature vectors. The feature vectors were split into train and test set in the ratio of 80 : 20. A wrapper based feature selection approach using Squirrel Search Algorithm (SSA) with the Support Vector Machine (SVM) classifier's accuracy as the fitness function was used to select the optimal features. The selected features were trained using the Back Propagation Neural Network (BPNN) classifier. This framework was tested on a real-time PE and covid-19 dataset. The BPNN classifier's accuracy with SSA yielded 88.02%, whereas, without SSA it yielded 83.80%. Statistical analysis, namely Wilcoxon's test, Kendall's Rank Correlation Coefficient test and Mann Whitney U test were performed, which indicates that the proposed method has a significant impact on the accuracy, sensitivity and specificity of the novel dataset considered. Comparative experimentations of the proposed system with existing benchmark ML classifiers, namely Cat Boost, Ada Boost, XGBoost, RBF SVM, Poly SVM, Sigmoid SVM and Linear SVM classifiers demonstrate that the proposed system outperforms the benchmark classifiers' results. [ FROM AUTHOR] Copyright of Journal of Intelligent & Fuzzy Systems is the property of IOS Press 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.)

Use of mechanical circulatory support guided by imaging modalities in treatment of influenza myocarditis: a case report

Introduction: Influenza affects millions worldwide every year. Although most cases are mild, severe complications can occur, including myocarditis1. Extracorporeal membrane oxygenation (ECMO) is a treatment option for patients with severe respiratory and/or cardiac failure. We present a case report of a patient with influenza-induced myocarditis and subsequent heart failure treated successfully with ECMO. Case report: 21-years-old male with no known history of medical illness presented to the Emergency Department at University Hospital Centre with fever, cough, and shortness of breath starting three weeks earlier. Chest X-ray showed pneumonia, PCR was COVID-19 negative but influenza positive. 12- lead electrocardiogram showed diffuse ST-segment elevation, cardiac biomarkers were elevated, and echocardiography verified reduced left ventricular ejection fraction (LVEF) of 44% with pericardial effusion. Patient was diagnosed with acute myopericarditis and pneumonia, admitted to hospital and started on broad-spectrum antibiotics. Four days later patient's respiratory distress worsened requiring intubation and mechanical ventilation. Hemodynamic status deteriorated requiring noradrenaline and dobutamine support. Bedside echocardiogram showed akinesia of inferolateral and anterolateral wall with severely reduced LVEF. Due to escalation of support and hemodynamic instability, decision was made to initiate veno-arterial (V-A) ECMO support. During the procedure patient had cardiac arrest and was successfully resuscitated two times. Two days later, patient was transported to University Hospital Centre Zagreb. Echocardiography showed LVEF of 20% while the chest X-ray showed signs of severe congestion interpreted as ECMO lung oedema. Due to that, an immediate implantation of Impella was performed. However, as soon as Impella established adequate cardiac output, a severe case of Harlequin syndrome developed which required conversion of ECMO configuration to V-A-V that stabilized the situation and enabled conversion into V-V ECMO two days later. Following further stabilization, VV ECMO was removed two days later, Impella the following day, and patient was extubated. Cardiac recuperation was dramatic and cardiac MRI showed an LVEF of 57%. Patient was discharged home after 24 days. Conclusion: This case highlights the appropriate use of different mechanical circulatory support modalities guided by different imaging modalities for bridging a case of severe influenza-induced myocarditis from a cardiac arrest situation to successful hospital discharge. [ FROM AUTHOR] Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society 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.)

Acetazolamide induced noncardiogenic pulmonary edema, an underreported serious adverse event.

Purpose: To report a case of acute noncardiogenic pulmonary edema (NCPE) after administration of acetazolamide post routine cataract surgery. Observations: 30 minutes after administration of oral acetazolamide, the patient experienced abdominal pain, nausea, vomiting, diarrhea, and diaphoresis. The patient was taken to the emergency room where she was found to have pulmonary edema. After life threatening respiratory failure resulting in prolonged intubation, the patient was eventually discharged from the hospital. Conclusions and importance: NCPE is a rare but severe adverse effect of acetazolamide and should be considered when prescribing such agents.

Incidence of Respiratory Pathogens in Naval Special Warfare SEAL Candidates with Swimming-Induced Pulmonary Edema.

BACKGROUND: Swimming-Induced Pulmonary Edema (SIPE) is a respiratory condition frequently seen amongst Naval Special Warfare (NSW) trainees. The incidence of positive respiratory panels (RPs) in trainees diagnosed with SIPE is currently unknown. RESEARCH QUESTION: Is there a significant difference in the incidence of respiratory pathogens in nasopharyngeal samples of NSW candidates with SIPE and a control group? STUDY DESIGN AND METHODS: Retrospective analysis of clinical information from NSW Sea Air and Land (SEAL) candidates diagnosed with SIPE over a 12-month period. Candidates who presented with the common signs and symptoms of SIPE received a nasopharyngeal swab and RP test for common respiratory pathogens. SIPE diagnoses were supported by two-view chest radiograph. RP tests were obtained for a selected control group of 1st phase trainees without SIPE. RESULTS: 45 of 1048 SEAL candidates were diagnosed with SIPE (4.3%). 5 had superimposed pneumonia. 36 of 45 tested positive for at least one microorganism on the RP (80%). In the study group, human rhinovirus/enterovirus (RV/EV) was the most frequently detected organism (37.8%), followed by coronavirus OC43 (17.8%), and parainfluenza virus 3 (17.8%). 16 of 68 candidates from the control group had positive RPs (24%). Patients with SIPE and positive RPs reported dyspnea (94%), pink-frothy sputum (44%), and hemoptysis (22%) more frequently than the controls with positive RPs. Those who reported respiratory infection symptoms in both the study and control groups had higher incidences of positive RPs (P=.046). INTERPRETATION: We observed that 80% of trainees diagnosed with SIPE tested positive on a point of care RP. This positivity rate was significantly higher than RP test results from the control cohort. These findings suggest an association between colonization with a respiratory pathogen and the development of SIPE in NSW candidates.

High altitude pulmonary edema at 2640 m altitude associated with an acute Rhinovirus infection. First case in the literature.

High altitude pulmonary edema (HAPE) is a multifactorial condition that may occur after ascent of high altitudes, especially in genetic predisposed individuals. Diagnosis is challenging and could lead to potentially lethal complications such as acute respiratory distress syndrome (ARDS). We present one of the few reported cases of HAPE below 3000 m of altitude, and the first to our knowledge to present with a concomitant acute Rhinovirus infection, precipitating and complicating the diagnosis and clinical course. Clinical manifestations, treatment, and outcomes are shown below.

Acute Pulmonary Edema as a Cardiovascular Manifestation of Pheochromocytoma.

Pheochromocytoma most commonly presents with the triad of paroxysms of headache, palpitations, and diaphoresis. Pheochromocytoma crisis, caused by a supra-physiological surge of catecholamine release, is an endocrine emergency that can present with various clinical manifestations. Acute pulmonary edema is one of the manifestations of pheochromocytoma crisis and can be either cardiogenic or non-cardiogenic. Here, we report cases of acute pulmonary edema of each type, related to pheochromocytoma crisis, which were presented to our district general hospital in 2020.

Symptomatic or asymptomatic SAR-CoV-2 positive divers should be medically evaluated before returning to scuba diving.

Introduction: In order to allow the resumption of diving activities after a COVID-19 infection, French military divers are required to undergo a medical fitness to dive (FTD) assessment. We present here the results of this medical evaluation performed 1 month after the infection. Methods: We retrospectively analyzed between April 2020 and February 2021 200 records of divers suspected of COVID-19 contamination. Data collected included physical examination, ECG, blood biochemistry, chest CT scan and spirometry. Results: 145 PCR-positive subjects were included, representing 8.5% of the total population of French military divers. Two divers were hospitalized, one for pericarditis and the other for non-hypoxemic pneumonia. For the other 143 divers, physical examination, electrocardiogram and blood biology showed no abnormalities. However 5 divers (3.4%) had persistent subjective symptoms including fatigability, exertional dyspnea, dysesthesias and anosmia. 41 subjects (29%) had significant decreases in forced expiratory flows at 25-75% and 50% on spirometry (n = 20) or bilateral ground-glass opacities on chest CT scan (n = 24). Only 3 subjects were affected on both spirometry and chest CT. 45% of these abnormalities were found in subjects who were initially asymptomatic or had non-respiratory symptoms. In case of abnormalities, normalization was obtained within 3 months. The median time to return to diving was 45 days (IQR 30, 64). Conclusion: Our study confirms the need for standardized follow-up in all divers after COVID-19 infection and for maintaining a rest period before resuming diving activities.

Biomarkers of alveolar epithelial injury and endothelial dysfunction are associated with scores of pulmonary edema in invasively ventilated patients.

BACKGROUND: Pulmonary edema is a central hallmark of Acute Respiratory Distress Syndrome (ARDS). Endothelial dysfunction and epithelial injury contribute to permeability but their differential contribution to pulmonary edema development remains understudied. METHODS: Plasma levels of surfactant protein-D (SP-D), soluble receptor for advanced glycation end products (sRAGE) and angiopoietin-2 (Ang-2) were measured in a prospective, multicenter cohort of invasively ventilated patients. Pulmonary edema was quantified using the radiographic assessment of lung edema (RALE) and global lung ultrasound (LUS) score. Variables were collected within 48 hours after intubation. Linear regression was used to examine the association of the biomarkers with pulmonary edema. RESULTS: In 362 patients, higher SP-D, sRAGE and Ang-2 concentrations were significantly associated with higher RALE and global LUS scores. After stratification by ARDS subgroups (pulmonary, non-pulmonary, COVID, non-COVID), the positive association of SP-D levels with pulmonary edema remained, while sRAGE and Ang-2 showed less consistent associations throughout the subgroups. In a multivariable analysis, SP-D levels were most strongly associated with pulmonary edema when combined with sRAGE (RALE score: ßSP-D = 6.79 units/log10 pg/mL, ßsRAGE = 3.84 units/log10 pg/mL, R2 = 0.23; global LUS score: ßSP-D = 3.28 units/log10 pg/mL, ßsRAGE = 2.06 units/log10 pg/mL, R2 = 0.086), while Ang-2 did not further improve the model. CONCLUSION: Biomarkers of epithelial injury and endothelial dysfunction were associated with pulmonary edema in invasively ventilated patients. SP-D and sRAGE showed the strongest association, suggesting that epithelial injury may form a final common pathway in the alveolar-capillary barrier dysfunction underlying pulmonary edema.

High-Altitude Pulmonary Edema in the Context of COVID-19

High-altitude pulmonary edema (HAPE) and COVID-19 pneumonia are different diseases, but HAPE-susceptible individuals (whose susceptibility often has a genetic basis) can also suffer from severe COVID-19. We hypothesized that certain pathogenic mechanisms might overlap if such a coincidence occurs, since these patients could react to alveolar hypoxia with a more intense and heterogeneously distributed pulmonary vasoconstriction than non-HAPE-susceptible patients. It is also not known how future altitude acclimatization might affect lowlanders with COVID-19 pulmonary sequelae, and how the loss of adaptation to chronic hypoxia might differ by genetic lineage among highland natives who have recovered from severe COVID-19 around the world. Although the incidence of CoV-2 in high-altitude locations seems to be lower, a correct differential diagnosis of both conditions is essential, especially in high-altitude areas where health resources are scarce, considering that there is sometimes a similarity between COVID-19 pneumonia and HAPE. © 2022 by the author.

Diagnosis of Pulmonary Edema and covid-19 from CT slices using squirrel search algorithm, support vector machine and back propagation neural network

A Computer Aided Diagnosis (CAD) framework to diagnose Pulmonary Edema (PE) and covid-19 from the chest Computed Tomography (CT) slices have been developed and implemented in this work. The lung tissues have been segmented using Otsu's thresholding method. The Regions of Interest (ROI) considered in this work were edema lesions and covid-19 lesions. For each ROI, the edema lesions and covid-19 lesions were elucidated by an expert radiologist, followed by texture and shape extraction. The extracted features were stored as feature vectors. The feature vectors were split into train and test set in the ratio of 80 : 20. A wrapper based feature selection approach using Squirrel Search Algorithm (SSA) with the Support Vector Machine (SVM) classifier's accuracy as the fitness function was used to select the optimal features. The selected features were trained using the Back Propagation Neural Network (BPNN) classifier. This framework was tested on a real-time PE and covid-19 dataset. The BPNN classifier's accuracy with SSA yielded 88.02%, whereas, without SSA it yielded 83.80%. Statistical analysis, namely Wilcoxon's test, Kendall's Rank Correlation Coefficient test and Mann Whitney U test were performed, which indicates that the proposed method has a significant impact on the accuracy, sensitivity and specificity of the novel dataset considered. Comparative experimentations of the proposed system with existing benchmark ML classifiers, namely Cat Boost, Ada Boost, XGBoost, RBF SVM, Poly SVM, Sigmoid SVM and Linear SVM classifiers demonstrate that the proposed system outperforms the benchmark classifiers' results. [ FROM AUTHOR]

A Case of Postpartum Pulmonary Edema With Preserved Ejection Fraction and Diastolic Capacity.

A 21-year-old female patient delivered vaginally at 40 weeks of gestation after an uneventful pregnancy. She bled profusely during delivery and underwent a blood transfusion and was discharged home on postpartum day 6. On postpartum day 8, she developed respiratory distress and visited our emergency room. She was admitted after a computed tomography scan showed evidence of pulmonary edema; pneumonia was suspected. After admission, her oxygenation worsened, and she was transferred to a higher institution. A PCR test performed at the higher institution was negative for coronavirus disease 2019, and echocardiography showed that the patient's ejection fraction was maintained. Oxygenation improved with oxygen administration alone, and the patient was transferred to our hospital on the same day. Echocardiography performed at our hospital showed no abnormalities in diastolic function, but the left ventricle was enlarged and mild mitral regurgitation was observed. Oxygenation gradually improved with diuretics and oxygen administration, and the patient was discharged home on the fifth day of hospitalization. An echocardiogram performed three months postpartum was normal.

Severe Respiratory Failure Developing in the Course of High-Altitude Pulmonary Edema in an Alpinist with COVID-19 Pneumonia: A Case Report.

Pigon, Katarzyna, Ryszard Grzanka, Ewa Nowalany-Kozielska, and Andrzej Tomasik. Severe respiratory failure developing in the course of high-altitude pulmonary edema in an alpinist with COVID-19 pneumonia: a case report. High Alt Med Biol. 23:372-376, 2022.-The case of a 38-year-old Polish alpinist, evacuated from base camp (4,200 m) under Lenin's Peak due to severe high-altitude pulmonary edema (HAPE) and symptoms of acute mountain sickness/high-altitude cerebral edema (HACE), is presented. Starting the expedition, the man was asymptomatic and had a negative COVID-19 molecular test. After a few days of trekking, he developed typical HAPE and HACE. After evacuation to the hospital in Bishkek, a diagnosis of acute bronchopneumonia was made by computed tomography (CT) imaging. A COVID-19 test was not performed at that time. After returning to Poland, a complete noninvasive cardiac and pulmonary assessment disclosed no pathology. The initial chest CT reassessment was read as demonstrating the densities typical for COVID-19 pneumonia, and a SARS-CoV-2 antibody test corroborated the diagnosis. Pre-existing lung disease increases the risk of developing HAPE. In the era of the COVID-19 pandemic, people traveling at a high altitude and unaware of the infection are at particular risk.

Atypical negative pressure pulmonary edema after extracorporeal membrane oxygenation therapy for COVID-19.

NPPE imaging findings were reported to show a preferential central and nondependent distribution. However, in our case, NPPE showed a peripheral accent pattern, resembling the ARDS pattern of COVID-19 pneumonia 4 months ago. Capillary damage from COVID-19 might still exist.

Radiographic assessment of lung edema (RALE) score and its association with clinical outcomes in acute respiratory distress syndrome in Colombia

Introduction: Acute respiratory distress syndrome (ARDS) is currently the main diagnosis in intensive care units (ICU) and is related to the SARS-CoV-2 pandemic. This syndrome increases hospital stay and costs, and has high mortality. Chest radiography is essential in these patients for diagnosis and clinical follow-up, as it is inexpensive and routinely used in the ICU. The RALE score (Radiographic assessment of lung edema) allows the estimation of the extension and density of alveolar opacities in chest radiography and has been associated with different clinical outcomes such as oxygenation, mortality at 28 days, ventilator-free days, hospital stay, and severity of ARDS. The objective of this work is to establish the association of RALE with clinical outcomes in patients with ARDS in our institution. Materials and methods: Ambispective, monocentric cohort study. Adults older than 18 years with a diagnosis of ARDS hospitalized in the ICUs of Hospital Santa Clara, Bogotá, Colombia, from January to December 2020, were included. Results: The study included 100 patients, 93% with a diagnosis of SARS-CoV-2, an association with RALE on the first day was found with oxygenation on the first day of admission, but without finding a statistically significant relationship between RALE and the other outcomes. Conclusion: The RALE score was not associated with relevant clinical outcomes in patients with ARDS. This can be explained by the different mechanisms of hypoxaemia in these patients. Further studies are suggested to confirm these findings. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo