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1.
Intelligent Automation and Soft Computing ; 34(2):1123-1139, 2022.
Article in English | English Web of Science | ID: covidwho-1884969

ABSTRACT

Pulmonary Embolism is a blood clot in the lung which restricts the blood flow and reduces blood oxygen level resulting in mortality if it is untreated. Further, pulmonary embolism is evidenced prominently in the segmental and subsegmental regions of the computed tomography angiography images in COVID-19 patients. Pulmonary embolism detection from these images is a significant research problem in the challenging COVID-19 pandemic in the venture of early disease detection, treatment, and prognosis. Inspired by several investigations based on deep learning in this context, a two-stage framework has been proposed for pulmonary embolism detection which is realized as a segmentation model. It is implemented as a cascade of convolutional superpixel neural network and a regularized UNet network for the segmentation of embolism candidates as well as embolisms, respectively. The proposed model has been tested with two public datasets and it has achieved a testing accuracy of 99%. The proposed model demonstrates high sensitivities of 88.43%, 88.36%, and 89.93% at 0, 2, and 5 mm localization errors, respectively for two false positives and they are superior to the state-of-the-art models, signifying potential applications in the treatment protocols of diverse pulmonary diseases and COVID-19.

2.
Biomedicines ; 10(6)2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1883993

ABSTRACT

BACKGROUND: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). METHODS: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. RESULTS: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). CONCLUSIONS: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.

3.
Kardiol Pol ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879824

ABSTRACT

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism (APE). Both pharmacological and invasive treatments for CTEPH are available in Poland, and awareness of the disease among physicians is growing. It has been suggested that the COVID-19 pandemic may increase the incidence of CTEPH and facilitate disease detection during more advanced stages of the illness. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation, in cooperation with independent experts in this field, launched the updated statement on algorithm to guide a CTEPH diagnosis in patients with previous APE. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months of effective anticoagulation, particularly when specified risk factors are present. Echocardiography is a main screening tool for CTEPH. A diagnostic workup of patients with significant clinical suspicion of CTEPH and right ventricular overload evident on echocardiography should be performed in reference centers. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Computed tomography pulmonary angiography with precise detection of thromboembolic residues in the pulmonary circulation is important for the planning of a pulmonary thrombendarterectomy. Right heart catheterization definitively confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for the identification of lesions suitable for thromboendarterectomy or balloon pulmonary angioplasty. In this document, a diagnostic algorithm for patients with suspected CTEPH is proposed. With an individualized and sequential diagnostic strategy, each patient can be provided with suitable and tailored therapy provided by the dedicated CTEPH Heart Team.

4.
Journal of Medical Internet Research ; 2022.
Article in English | ProQuest Central | ID: covidwho-1871157

ABSTRACT

Background: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, s, and keywords. A term map was constructed for findings visualization. Results: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth.

5.
Diagnostics (Basel) ; 12(5)2022 May 09.
Article in English | MEDLINE | ID: covidwho-1862748

ABSTRACT

PURPOSE: To evaluate the use of pulmonary computed tomography (CT) angiography during initial admission at an emergency department (ED), to identify COVID-19 patients with accompanying pulmonary embolism (PE) and its impact on clinical management. METHODS: We performed a retrospective analysis of COVID-19 patients that underwent pulmonary CT angiography at the ED. CT scans were evaluated for the presence and extent of PE and for imaging changes suspicious of COVID-19. Patients were subdivided into two groups: (1) Group A consisted of patients with proven COVID-19 based on real-time polymerase chain reaction (RT-PCR), and (2) Group B of patients suspected for COVID-19, comprising patients positive on RT-PCR and/or COVID-19-suspicious CT findings. To assess the differences between patients with and without pulmonary embolism, Fisher's exact test was used. RESULTS: A total of 308 patients were admitted to the ED for diagnostic work-up of dyspnea and suspected COVID-19, and 95 patients underwent pulmonary CT angiography. PE was detected in 13.6% (3/22) of patients in Group A and 20.7% (6/29) in Group B. No significant differences were observed between patients with and without PE concerning hospitalization (Group B: 100% (6/6) vs. 91.3% (21/23)), the necessity of oxygen therapy (Group B: 66% (4/6) vs. 43.5% (10/23)), and death (Group B: 33% (2/6) vs. 4.3% (1/23) p > 0.05, respectively). CONCLUSIONS: In 20.7% of COVID-19 patients, PE was detected upon admission to the ED. Although the incorporation of early pulmonary CT angiography in patients suspicious of COVID-19 may be beneficial to identify concomitant PE, further studies are necessary to corroborate these findings.

6.
British Journal of Haematology ; 197(SUPPL 1):208-209, 2022.
Article in English | EMBASE | ID: covidwho-1861261

ABSTRACT

University Hospitals Plymouth, NHS trust, is a teaching hospital of 850 beds which has been a venous thromboembolism (VTE) exemplar centre since 2010. Data on VTE events, importantly whether hospital acquired, have been produced over the same period (Table 1). Data are also collected on the number and type of radiology scans used. Specifically, computed tomography pulmonary angiography (CTPA), ventilation perfusion scans (V/Q) and Doppler ultrasound of upper and lower limbs (DUS). The first COVID positive patient was admitted in March 2020;subsequently a flood of such patients led to many hospital services being paused and initially a reduction in number of patients admitted including those with VTE. In 2020 the total number of VTE events were relatively similar to data from the previous 10 years, being 765 against an average of 793 (SD 57.33) over the preceding 10 years. Hospital acquired VTE (HAT) in 2020 was 175 compared with an average of 189 (24%) per year previously. Compared with the last 3 years, similar numbers of CTPA were carried out in 2020 at 2229 against 2152. V/Q scans were significantly reduced (270) over concerns related to using inhaled gases in COVID patients. This compares with an average of 636. For DUS similar numbers 2714 were undertaken (previously 2785). Over 2021 there has been an increase in total VTE (944, an increase of 23 %), in particular an increase in total PE from an average of 454 over the preceding 11 years to 590 (30% increase) last year. DVT totalled 336, compared to 354 last year, being relatively similar. There has also been a similar increase in scan numbers for 2021 with CTPA registering 3171 an increase in 942 scans. For DUS scans similar numbers for 2021, at 2927 compared to the average over the last 3 years of 2785. Hospital acquired VTE was 206 (22%) a similar percentage from immediately previous years. Of the positive VTE events 72 (8%) were associated with a positive COVID diagnosis with a significant increase presenting as PE (93%) over DVT (7%). There is likely to be an association between VTE increase relating to shielding and furlough, causing a decrease in usual physical activity. It is not entirely clear why there has been such a significant increase in total PE diagnosed as there has been no change to protocol or scanning equipment used. However, COVID is a respiratory virus and causes significant inflammation within the lungs, which may well have an impact in increasing PE risk. An initial review of the data seems to confirm there are no significant differences in other VTE risk factors. We will continue to collect outcome data on all VTE events next year, to identify whether this increase continues or whether 2021 was an exceptional year for positive VTE events..

7.
Lung India ; 39(SUPPL 1):S138, 2022.
Article in English | EMBASE | ID: covidwho-1857681

ABSTRACT

Background: Post COVID -19 infection has wide range of presentation, cavitation and fungal infections were very common in these patients especially when they are immune compromised. This is a case study of a post covid patient with cavitary consolidation and Rasmussen's aneurysm secondary to invasive aspergillus infection. Case Study: A 62 year old gentleman, hypertensive, diabetic and survivor of severe COVID-19 infection presented with low grade fever, breathlessness and cough with expectoration. The CT scan showed bilateral cavitary consolidation . Sputum examination showed aspergillus growth and MTB negative. Serum galactomannan was positive. While getting treated with antifungal therapy for invasive aspergillus infection, he had one episode of massive haemoptysis. CT angiography showed Rasmussen aneurysm and planned for bronchial artery embolization. But the patient was not willing for any urgent intervention and got discharged on request after stabilisation, warning signs were explained. After 5 days patient had massive haemoptysis followed by circulatory collapse. Patient could not be saved even after resuscitation measures and emergency intubation. Discussion: Rasmussen's aneurysm is a pseudo-aneurysmal dilatation of a branch of pulmonary artery secondary to chronic inflammation in a contiguous cavity. The reported incidence of such pathology is around 5% in cavitary lesions. It may ruptures into the cavity, producing massive haemoptysis. Conclusion: Rasmussen aneurysm itself is a very dangerous entity irrespective of its etiology. Early interventions to prevent the fatal haemoptysis is the management strategy as conservative treatment may not give us enough time to act at the time of emergency.

8.
Lung India ; 39(SUPPL 1):S129, 2022.
Article in English | EMBASE | ID: covidwho-1857635

ABSTRACT

Introduction: The invasion of lung tissue by a commensal like aspergillus after severe viral infection has been known.[1] But coronavirus has multiple fangs like immune dysfunction, precipitates new onset diabetes and hypercoagulability.[2] We hereby present a case of long COVID with pulmonary aspergillosis and deep vein thrombosis (DVT). Case Study: A 46 year old male presented with one and half month history of fever, cough with expectoration, hemoptysis. He had tested positive for COVID and diabetes two months before and had required intensive care treatment. The Chest Xray [Figure 1a] showed left upper lobe opacity. Chest CT Scan [Figure 2] showed cavity with central hypodense component within anterior segment of left upper lobe (bird's nest appearance). BAL from that segment grew aspergillus. The patient was started on voriconazole, hemoptysis was controlled and subsequently discharged. But 15 days later, he was readmitted with hemoptysis and left side calf pain and swelling. Lower limb venous doppler showed thrombosis of parts of Left Superficial femoral vein and popliteal vein. CTPA (CT Pulmonary Angiography) didn't show any filling defect. Patient was started on anticoagulation. After 8 weeks patient improved with significant clearing of lung lesion on chest X Ray [Figure 1b]. Discussion: Studies from Wuhan, China, reported secondary fungal infections in 35.3% critically ill patients.[3] Our patient, apart from other risk factors had received corticosteroids and the dose was more than 0.3 mg/kg/d and the duration was upto 4 weeks.[4] Conclusion: Post COVID cases with hemoptysis should be investigated properly considering the multiple pathogenic pathways that are implicated by this virus.

9.
Lung India ; 39(SUPPL 1):S79-S80, 2022.
Article in English | EMBASE | ID: covidwho-1856943

ABSTRACT

Introduction: Pseudoaneurysm of the pulmonary artery (PAP) is a rare cause of hemoptysis with a wide array of aetiologies. This case report discusses our clinical experience of PAP associated with pulmonary mucormycosis (PM) in a COVID survivor. Case Report: A 58-year-old gentleman presented with a 1-week history of high-grade fever and progressive dry cough. Four weeks before his presentation, he was treated for mildly symptomatic COVID-19 infection with unusually high doses of steroids. On admission, a chest x-ray and CT chest showed a cavitatory lesion in the right lower lobe. He underwent a FOB with BAL and endobronchial biopsy, which were inconclusive. On day 5 of his hospital admission, he had an episode of massive hemoptysis leading to hemodynamic instability. CT showed an increase in the size of the cavity and a pulmonary angiogram showed the descending segmental branch of the right pulmonary artery traversing through the consolidative cavitating lesion with focal dilatation of the same measuring up to 1.5 x 1.9 cm. Consistent hemostasis couldn't be achieved after gluing an interlock coiling of pseudoaneurysm, hence he underwent video-assisted thoracic surgery for right lower lobectomy and stump ligation of the right lobar pulmonary artery. Lobectomy specimen on histopathology revealed large areas of necrosis with aseptate fungal hyphae. He responded well to antifungal therapy during follow on 4th week post discharge. Conclusion: Mucormycosis is characterized by angioinvasion, vessel thrombosis, and subsequent tissue thrombosis. Pseudoaneurysm formation is rarely seen in PM and can be associated with fatal hemoptysis. Irrational use of systemic steroids in the management of COVID makes the patient more vulnerable to an otherwise rare disease.

10.
Pakistan Journal of Medical and Health Sciences ; 16(3):188-189, 2022.
Article in English | EMBASE | ID: covidwho-1856775

ABSTRACT

Aim: To evaluate the safety and success of facial artery ligation alone in arteriovenous malformation of upper lip in non-affording patients. Methodology: This prospective study was conducted at Department of Plastic surgery, on 11 consecutive patients with recurrent upper lip arteriovenous malformation who couldn’t afford angioembolization and frequent hospital visits for staged procedures. We did debulking of lesion after facial artery ligation and cosmetic lip correction. Results: Total 11 patients (9 males and 2 females) were included in this study. Majority of patients showed satisfactory results with facial artery ligation alone. One patient lost the follow up. No significant complication was noted in any patient. No recurrence was noted at 6 months and 1 year follow-up. Patient satisfaction rate remained 8.6±0.96 as per VAC. Conclusion: facial artery ligation alone provides an easy and approachable option for arteriovenous malformation where cost affordability for angioemboization and repeated hospital visits are main limitations.

11.
Vision (Basel) ; 6(2)2022 May 16.
Article in English | MEDLINE | ID: covidwho-1855865

ABSTRACT

BACKGROUND: Endothelial cells damage and thromboinflammation are considered key elements in the generation of organ impairment in patients with COVID-19 disease. The endothelial function is evaluated by measuring flow-mediated dilation (FMD). We aimed to analyze the association between FMD impairment and retinal vascular parameters in early post-COVID-19 patients. 00118-00199Tomography (OCT), OCT Angiography (OCTA) and slit lamp examination were performed. FMD ≤ 7% was considered as pathological. Our primary outcome was to assess potential differences in the radial peripapillary capillary plexus flow index (RPCP-FI) and RPCP density (RPCP-D) values between post-COVID-19 patients with and without FMD impairment. The associations of other retinal vascular parameters with FMD impairment were assessed as secondary endpoints. RESULTS: FMD impairment was detected in 31 patients (37.8%). RPCP-FI (p = 0.047), age (p = 0.048) and prevalence of diabetes (p = 0.046) significantly differed in patients with FMD ≤ 7% in regression analysis. RPCP-FI was linearly correlated with FMD values (R = 0.244, p =0.027). SCT was found to be lower in patients with impaired FMD (p = 0.004), although this difference was only a trend in binary logistic regression output (p = 0.07). CONCLUSIONS: Early post-COVID-19 patients showed a higher prevalence of FMD impairment compared to the general population. Age, diabetes and RPCP-FI were independently correlated with the presence of endothelial impairment in the early post-infective period.

12.
Immun Inflamm Dis ; 10(6): e619, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1850061

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic in an unprecedented time frame. Systemic vascular involvement in COVID-19 has been identified, and SARS-CoV-2 has also been found to cause multiple organ ischemia and posterior ocular segment disease in mammals, raising concerns about the human retinal microvascular involvement in SARS-CoV-2. OBJECTIVE: To objectively assess the presence of retinal microvascular impairment in COVID-19 patients by optical coherence tomography angiography (OCTA), so as to facilitate the clinical system management of COVID-19 patients. METHODS: We searched PubMed, Cochrane Library, EMBASE, Ovid, CBM to collect eligible studies. The main outcomes included the vessel density (VD), area or perimeter of foveal avascular zone (FAZ), central foveal thickness (CFT), subfoveal choroidal thickness (SCT) in our meta-analysis. RESULTS: We eventually included five studies with a total of 401 participants. Our meta-analysis showed that nonacute infectious COVID-19 or post-COVID-19 patients presented significantly lower foveal VD of deep capillary plexus (WMD = -4.22, 95% CI [-8.00, -0.43]) and thinner SCT (WMD = -10.33, 95% CI [-19.08, -1.57]) than healthy controls. The foveal VD and parafoveal VD of superficial capillary plexus, parafoveal VD of deep capillary plexus, CFT, area, and perimeter of FAZ showed no significant differences between the groups. CONCLUSION: The patients of nonacute infectious COVID-19 or post-COVID-19 displayed alterations in the retinal microvasculature and choroidal vessels, including a significantly lower foveal VD in deep capillary plexus and thinner SCT. The impairment may be a medium to long-term process. Close ophthalmic surveillance is necessary for COVID-19 patients or post-COVID-19 patients.


Subject(s)
COVID-19 , Retinal Vessels , Fluorescein Angiography/methods , Humans , Retina/diagnostic imaging , Retinal Vessels/diagnostic imaging , SARS-CoV-2
13.
Photodiagnosis Photodyn Ther ; : 102920, 2022 May 18.
Article in English | MEDLINE | ID: covidwho-1851922

ABSTRACT

BACKGROUND: To investigate retinal microvascular morphological changes in previously COVID-19 infected patients using optical coherence tomography angiography (OCTA), and compare the findings to age- and gender-matched healthy subjects. METHODS: In this cross-sectional study, OCTA findings (6.0 × 6.0 mm scan size and scan quality index ≥7/10) from previously COVID-19 infected patients (group 1, 32 patients, 64 eyes) with ≥1 month of complete recovery were compared to healthy subjects (group 2, 33 subjects, 66 eyes) with no history of COVID-19 infection. A positive real-time reverse transcription-polymerase chain reaction test on a naso-pharyngeal swab sample confirmed the diagnosis. The AngioVueAnalytics, RTVue-XR 2017.1.0.155 software measured and recorded OCTA parameters. RESULTS: Group 1 had significantly lower superficial capillary plexus vessel densities in all foveal regions than group 2 (P<0.05). Foveal deep capillary plexus vessel density in group 1 was also significantly lower than in group 2 (P=0.009); however, no significant differences were found in other regions (P>0.05). All foveal avascular zone (FAZ) parameters were higher in group 1 than in group 2, with significant differences in FAZ area (P=0.019) and foveal vessel density 300 µm area around FAZ (P=0.035), but not FAZ perimeter (P=0.054). The outer retina and choriocapillaris flows were significantly lower in group 1 than in group 2 (P<0.05). CONCLUSIONS: Prior COVID-19 infection seems to be associated with significant changes in retinal microvascular density, as well as FAZ and flow parameters, which may be attributed to different pathogenic mechanisms that lead to SARS-CoV-2 infection, such as thrombotic microangiopathy and angiotensin-converting enzyme 2 disruption.

14.
Int Ophthalmol ; 2022 May 11.
Article in English | MEDLINE | ID: covidwho-1844413

ABSTRACT

INTRODUCTION: The role of the human eye in severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is still under investigation. The pathophysiology of the ocular findings is arduous when dealing with critically ill Covid-19 patients with comorbidities. Multiorgan involvement and the effects of inflammation, infection and systemic treatment on the retina are complex, and comparison of studies is difficult. Most studies in human patients have investigated the anterior segment, whereas few reports deal with the posterior segment of the eye. The present review aims to evaluate the retinal manifestations and imaging features in COVID-19 patients. METHODS: Studies on the retinal manifestations and retinal imaging in COVID-19 patients published through June 2021 were reviewed. We included cross-sectional and case-control studies, case series, case reports and correspondence in the analysis. RESULTS: Flame-shaped hemorrhages, cotton wool spots, augmented diameter and tortuosity of retinal vessels were found on funduscopic examination. Peripapillary, macular retinal nerve fiber layer and ganglion cell layer thickness alterations were reported on spectral domain optical coherence tomography. Reduced vessel density of the superficial and deep retinal capillary plexus on optical coherence tomography angiography was reported. CONCLUSIONS: Retinal complications may arise in COVID-19 patients. Although no consensus on presentation is currently available, retinal funduscopy and imaging has shown neuronal and vascular alterations. Systemic neurological complications and microangiopathy are associated with SARS-COV-2; thus, as the retina has a neuronal and vascular component, funduscopy and retinal imaging on COVID-19 patients can provide further insight to SARS-COV-2 disease and the follow-up of patients.

15.
Ann Med Surg (Lond) ; 77: 103724, 2022 May.
Article in English | MEDLINE | ID: covidwho-1821119
16.
Tomography ; 8(3): 1228-1240, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1820401

ABSTRACT

(1) Background: Spontaneous retroperitoneal hematomas are a relatively common occurrence in hospitalized patients with COVID-19 related pneumonia, and endovascular treatment of trans-arterial embolization (TAE) may be a life-saving procedure after failure of medical and supportive therapy. The aim of our study was to evaluate spontaneous retroperitoneal hematomas in the COVID-19 era, focusing on their imaging features at CTA and DSA and on the safety, as well as technical and clinical success, of TAE, comparing patients affected by COVID-19 and non-COVID-19 patients. (2) Materials and Methods: We retrospectively enrolled 24 patients with spontaneous retroperitoneal hematoma who underwent TAE; of these, 10 were hospitalized for COVID-19-related pneumonia, while the other 14 were without COVID-19 infection. We evaluated the demographic data, hemoglobin values before and after the procedure, preprocedural aPTT, preprocedural INR, diagnostic and interventional imaging findings, procedural outcome (technical success) and survival periprocedural (clinical success), and major and minor complications. (3) Results: The mean age of the study population was 72.7 ± 11.2 years. CTA revealed signs of active bleeding in 20 patients (83%). DSA showed signs of active bleeding in 20 patients (83%). In four patients (17%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 17 patients (71%), while seven patients (29%) rebled within 96 h, and all of them were retreated. No major periprocedural complication was reported. The comparison between the two groups did not show statistically significant differences for gender, mean age, mean pre- and postprocedural hemoglobin, aPTT and INR, mean hematoma volume (cm3), or mean delay between CT and DSA. Active bleeding at CTA was detected in 90% of COVID-19 patients and 79% of non-COVID-19 patients (p = 0.61). At DSA, active bleeding was assessed in eight out of 10 (80%) patients in the COVID-19 group and 12 out of 14 (86%) patients in the non-COVID-19 group (p = 1). Technical success was obtained in 100% of patients in both groups. Clinical success rates were 70% for COVID-19 group and 71% for the non-COVID-19 group. We found no statistical significance between the clinical success rates of retroperitoneal spontaneous hematoma embolization in patients with or without SARS-CoV-2 infection. (4) Conclusions: We suggest that, similar to what has been reported in other studies in non-COVID-19 patients, TAE should be considered an important safe, effective, and potentially life-saving option for the management and the treatment of patients affected by COVID-19 who present with spontaneous retroperitoneal hematoma and who could not benefit from conservative treatment.


Subject(s)
COVID-19 , Aged , Aged, 80 and over , COVID-19/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Hematoma/diagnostic imaging , Hematoma/etiology , Hematoma/therapy , Humans , Middle Aged , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
17.
Neuroradiol J ; : 19714009221096828, 2022 May 03.
Article in English | MEDLINE | ID: covidwho-1820113

ABSTRACT

BACKGROUND AND PURPOSE: The COVID-19 pandemic acutely disrupted all facets of healthcare, with future implications that are expected to resonate for many years. We investigated the effect of the pandemic on neuroimaging volume, hypothesizing that all representative studies would experience a reduction in volume, with those typically performed in the inpatient setting (noncontrast enhanced CT head and CTA head/neck) taking longer to recover to pre-pandemic volumes compared to studies typically performed in the outpatient setting (MR brain with and without and MR lumbar spine without). MATERIALS AND METHODS: We retrospectively queried our institution's radiology reporting system to collect weekly data for 1 year following the World Health Organization declaration of a pandemic (11 March 2020-9 March 2021) and compared them to imaging volumes from the previous year (11 March 2019-9 March 2020). We subsequently analyzed quarterly data (e.g., first quarter comparison: 3/11/2020-6/9/2020 was compared to 3/11/2019-6/9/2019). RESULTS: All studies experienced decreased volume during the first quarter of the year following onset of the COVID-19 pandemic, with noncontrast enhanced CT head failing to recover to pre-pandemic volumes. CTA head/neck actually surpassed pre-pandemic volume by the second quarter of the year. MRI brain w/wo and MRI lumbar spine without recovered to baseline volume by the second quarter. CONCLUSION: Noncontrast enhanced CT head did not recover pre-pandemic imaging volume. CTA head/neck volume initially decreased, however volume increased above pre-pandemic levels during the second quarter; this finding may be attributable to a prothrombotic state in COVID-19 patients.

18.
Cardiogenetics ; 12(2):133-141, 2022.
Article in English | EMBASE | ID: covidwho-1818054

ABSTRACT

Eosinophilic pancarditis (EP) is a rare, often unrecognized condition caused by endomyocardial infiltration of eosinophil granulocytes (referred as eosinophilic myocarditis, EM) associated with pericardial involvement. EM has a variable clinical presentation, ranging from asymptomatic cases to acute cardiogenic shock requiring mechanical circulatory support (MCS) or chronic restrictive cardiomyopathy at high risk of progression to dilated cardiomyopathy (DCM). EP is associated with high in‐hospital mortality, particularly when associated to endomyocardial thrombosis, coronary arteries vasculitis or severe left ventricular systolic dysfunction. To date, there is a lack of consensus about the optimal diagnostic algorithm and clinical management of patients with biopsy‐proven EP. The differential diagnosis includes hypersensitivity myocarditis, eosinophil granulomatosis with polyangiitis (EGPA), hypereosinophilic syndrome, parasitic infections, pregnancy‐related hypereosinophilia, malignancies, drug overdose (particularly clozapine) and Omenn syndrome (OMIM 603554). To our knowledge, we report the first case of pancarditis associated to eosinophilic granulomatosis with polyangiitis (EGPA) with negative anti‐neutrophil cytoplasmic antibodies (ANCA). Treatment with steroids and azathioprine was promptly started. Six months later, the patient developed a relapse: treatment with subcutaneous mepolizumab was added on the top of standard therapy, with prompt disease activity remission. This case highlights the role of a multimodality approach for the diagnosis of cardiac involvement associated to systemic immune disorders.

19.
Clinical Neurosurgery ; 67(SUPPL 1):194-195, 2020.
Article in English | EMBASE | ID: covidwho-1816194

ABSTRACT

INTRODUCTION: There are increasing reports of a pediatric multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) that presents with varying clinical features, but includes features of Kawasaki disease or toxic shock syndrome. Symptoms include fever, rash, abdominal pain, vomiting, and diarrhea. Many patients present without any respiratory symptoms and testing for SARS-CoV-2 is often negative. METHODS: A retrospective chart review was performed. RESULTS: A 7-year-old previously healthy male presented with 3 days of fevers up to 102.4F, headaches, abdominal pain, and intractable vomiting. Both parents had tested positive for SARS-CoV-2 four weeks prior. Nasopharyngeal swab tested positive for SARS-CoV-2 RNA. Echocardiogram was normal. CT venogram of his head was negative for any pathology. He developed severe neck pain and persistent headache during his hospitalization. Soon after receiving hydroxychloroquine, he developed a facial rash and altered mental status with episodes of aphasia, agitation, and pinpoint pupils. He then became unresponsive with left gaze deviation. A non-contrast head CT and CT angiography were negative. He was given levetiracetam and cefazolin and transferred to the pediatric intensive care unit. An electroencephalogram (EEG) showed no epileptiform activity. Over the following 7 hours, the EEG demonstrated left frontotemporal slowing, which progressed into a loss of fast activity over the right hemisphere with increased delta activity in the left hemisphere, then abruptly changed to generalized voltage attenuation.He rapidly lost brainstem reflexes, developing fixed and dilated pupils. Repeat CT scan revealed diffuse cerebral edema with loss of gray-white differentiation. Lab results then were consistent with severe inflammation. An intracranial pressure monitor revealed pressures greater than 76 mmHg. His exam soon became consistent with brain death. Pathologic evaluation showed diffuse cerebral edema with perivascular mononuclear infiltrates. CONCLUSION: The cause of this pediatric multi-system inflammatory syndrome is unclear and the mechanism by which SARS-CoV-2 affects the nervous system is unknown. Pediatric patients with COVID-19 and neurologic symptoms should be closely monitored as they can rapidly decline due to fulminant cerebral edema.

20.
J Ophthalmic Inflamm Infect ; 12(1): 15, 2022 Apr 27.
Article in English | MEDLINE | ID: covidwho-1817176

ABSTRACT

BACKGROUND/PURPOSE: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in the pediatric population and anterior uveitis is its commonest extra-articular manifestation. Typically the uveitis presents as chronic anterior uveitis and there is limited literature of the posterior segment manifestations of the disease. Similar to other vaccines, anti-SARS-CoV-2 vaccination that began as an urgent measure to control the spread of the SARS-CoV-2 pandemic has not been without adverse events. We are reporting a 19-year-old Asian Indian female who was diagnosed and treated for JIA associated anterior uveitis that was unilateral and was under anti-inflammatory control but showed worsening of uveitis with posterior segment inflammation in both eyes following anti-SARS-CoV-2 vaccination. CASE REPORT: A 19-year-old Asian Indian female with a history of juvenile idiopathic arthritis on treatment with methotrexate, presented with right eye chronic anterior uveitis with peripheral subclinical retinal vasculitis and macular edema which was brought under control following administration of adalimumab. She was inflammation free for 6 months until she received anti-SARS-CoV-2 vaccination and developed new onset floaters in both eyes that were initially noted after the first dose and increased after the second dose. Clinical examination revealed presence of keratic precipitates and grade 1+ anterior chamber inflammation along with vitiritis in both eyes. Fundus fluorescein angiography revealed angiographically active retinal vasculitis without the presence of macular edema in both eyes. This was managed with a short course of topical difluprednate and continuation of systemic immunosuppressive therapy with adalimumab and methotrexate. CONCLUSION: JIA associated uveitis results from an autoimmune process which can be controlled with timely immunosuppressive treatment. It is important to be aware of the potential risk of flare up of uveitis with posterior segment manifestations following anti- SARS-CoV-2 vaccination.

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