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1.
HIV Nursing ; 23(1):804-808, 2023.
Article in English | CINAHL | ID: covidwho-2205837

ABSTRACT

Covid-19 disease that directly affecting lungs is an acute disease caused death of many people around word, so the early detecting of it and asses the relative ratio of the lung infection is a vital need. In this work, Histogram based contrast adjustment was implemented to enhance four lung abnormal CT scan images to highlight the abnormal regions within the experimental images. Fuzzy c-mean algorithm then was applied to segment the images in order to detect and isolate the infected regions. Besides, several morphological operations were employed to extract the refined infected Covid-19 areas effectively with accuracy of 96%.

2.
Galician Medical Journal ; 29(4), 2022.
Article in English | Web of Science | ID: covidwho-2204969

ABSTRACT

Background. An interleukin-6 (IL-6) is a proinflammatory cytokine which plays an important role in COVID-19-associated hyperinflammation.Aim. This study aimed to assess the predictive ability of serum IL-6 levels for the development of se-vere/critical clinical conditions, a hypoxemic state requiring supplemental oxygen, and lethal outcomes in patients with COVID-19-associated pneumonia and arterial hypertension (AH).Materials and Methods. One hundred and thirty-five unvaccinated patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. AH was diagnosed in 78.5% of cases. Pneumonia was confirmed radiologically. SARS-COV-2 as an etiological factor was confirmed by either PCR or ELISA. In addition to conventional laboratory tests, IL-6, ferritin, and soluble interleukin-2 levels were measured.Results. Among AH patients, the median levels of IL-6 were higher in non-survivors (95.1 [37.8--158.8] pg/mL) as compared to survivors (39.5 [13.6-81.1] pg/mL) (p = 0.04). Among AH patients, the median serum level of IL-6 was 98.3 [37.8-158.8] pg/mL in critically ill patients, 41.7 [11.8-83.4] pg/mL in severely ill patients, 37.8 [13.6-74.4] pg/mL in moderately ill patients (p = 0.051). The median serum level of IL-6 was lower at the time of discharge (6.5 [2.0-21.5] pg/mL) as compared to that on admission (43.2 [16.1-92.0] pg/mL) (p < 0.001). IL-6 level failed to predict severe/critical condition (AUC = 0.59, p = 0.13) and the need for supplemental oxygen (AUC = 0.61, p = 0.06);however, it might be used for the prediction of the lethal outcome (AUC = 0.69, p = 0.03). The cut-off value of IL-6 level for lethal outcome prediction of 91.0 pg/mL showed a sensitivity of 58.3% and a specificity of 78.7%. Patients with IL-6 levels > 91.0 pg/mL on admission had higher odds of lethal outcomes (OR = 4.87 [1.40-16.92], p = 0.01).Conclusions. Serum IL-6 level on admission did not show significant predictive ability for severe/critical conditions and hypoxemic states requiring supplemental oxygen in AH patients. However, serum IL-6 levels on admission were higher in non-survivors and might be used for the prediction of lethal outcomes with a cut-off value of 91.0 pg/mL in AH patients.

3.
Messenger of Anesthesiology and Resuscitation ; 19(5):55-62, 2022.
Article in Russian | Scopus | ID: covidwho-2204892

ABSTRACT

261, 435, 768 COVID-19 infections were detected worldwide, of them 5, 207, 634 deaths were registered. Identifying markers of the patient severity early in the course of the disease can facilitate the assessment of the risk of adverse outcome. The objective: To compare values of laboratory parameters and their changes during treatment of patients with a complicated course of COVID-19 infection. Subjects and Methods. 56 patients were included in the study, all of them were hospitalized to COVID Hospital of the Clinic of Bashkir State Medical University, Russian Ministry of Health, from September 30, 2021 to November 15, 2021, and their complicated course of the disease necessitated transfer to the intensive care unit (ICU). The laboratory evaluation included the following: a general blood and urine counts, blood chemistry including urea and creatinine, liver transaminases, and blood coagulogram (prothrombin time (PTT), prothrombin index (PTI), thrombin time, fibrinogen, and blood clotting time). Results. In the group of patients with a fatal outcome on the day of transfer to ICU, lymphocytopenia, eosinopenia, elevated values of creatinine, total bilirubin, transaminases, C-reactive protein, D-dimer, and ferritin were noted. Also on this day, microscopic hematuria, proteinuria and cylindruria were detected in the urine tests of most patients in this group during treatment. Conclusion. Critical deviations in the results of hematological and biochemical tests were revealed. Particular attention should be paid to such parameters as the level of erythrocytes, lymphocytes, eosinophils, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, C-reactive protein, D-dimer, and ferritin. © 2022 The authors.

4.
Journal of Cardiovascular Magnetic Resonance ; 24(1):73, 2022.
Article in English | MEDLINE | ID: covidwho-2196336

ABSTRACT

The global pandemic of coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory suyndrome coronavirus 2 (SARS-CoV-2) is now entering its 4th year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. While pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play, RTP) following resolution of infection. A variety of different testing combinations that leverage the electrocardiogram, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance (CMR) imaging have been proposed and implemented to mitigate risk. CMR in particular affords high sensitivity for myocarditis but has been employed and interpreted non-uniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to RTP. This consensus document synthesizes available evidence to contextualize the appropriate utilization of CMR in the RTP assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.

5.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128276

ABSTRACT

Background: The problem of determining the significance of individual laboratory markers that allows in the early stages of community-acquired pneumonia, in including during SARS-CoV- 2 infection, to predict both the nature of the course of the disease and possible poor prognosis. Aim(s): To assess the predictive value of an increased D-dimer in a new coronavirus infection caused by SARS-CoV- 2. Method(s): The diagnostic significance of the D-dimer level in predicting the severity of COVID19 infection was assessed based on the accumulated literature and real clinical practice. The methods of bibliographic and informational search in Scopus, CORE, eLIBRARY databases were used. The keywords for the search were: D-dimer, DIC-syndrome, SARS-CoV- 2, COVID-19. A total of 52 literary sources were found, of which 21 articles were selected for further analysis. To study real clinical practice, the level of D-dimer was analyzed in 109 patients diagnosed with a confirmed new coronavirus infection caused by SARS-CoV- 2, moderate pneumonia, hospitalized in the covid department of the Volosevich First City Clinical Hospital in Arkhangelsk. Result(s): The D-dimer is the most significant marker of the severity of the disease and predicting the risk of death in SARS-CoV- 2 infection, both according to the literature and in real clinical practice. There is a relationship between the severity of the inflammatory process and the state of thrombinemia in community-acquired pneumonia of both bacterial and viral genesis, including influenza and SARS-CoV- 2 Conclusion(s): The main significance of elevated D-dimer levels in patients with COVID-19 is associated with the activation of coagulation against the background of systemic inflammation, ultimately leading to the disseminated intravascular coagulation syndrome, which must be taken into account in the treatment of the new coronavirus infection.

6.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128145

ABSTRACT

Background: Critically ill patients with COVID 19 are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population yet. Aim(s): The present sub study of national project (20.80009.8007.28) aimed to assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients with coronavirus SARSCOV2. Method(s): Study included patients with PE. A sub analyses was performed on patients with COVID positive test. Pulmonary CT angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. Patients were dichotomized into low and intermediate/high probability groups. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis. Result(s): Of 108 patients, 42 (38.8%) were positive for PE based on pulmonary CTA. The mean group value of the Wells score was 3.8 points, with 46.2% of patients having a score of >=3, which qualifies the patient with probable PE. The average value of the Geneva score represents 7.78 points, and 60.99% of patients qualify in the group with probable PE. According to the Wells and revised Geneva scores, (52.2%) patients and (39.1%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 25.8% had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.64 for the Wells score and 0.56 for the revised Geneva score. Wells score >4 had a sensitivity of 38%, specificity of 77%, positive predictive value of 49%, and negative predictive value of 73% to predict risk of PE. Conclusion(s): In this population of critically ill patients with covid 19, Wells and revised Geneva scores were not reliable predictors of PE.

7.
Diagnostics (Basel) ; 12(4)2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-2114890

ABSTRACT

Speckle tracking echocardiography has emerged as a sensitive tool to analyze myocardial function with improved diagnostic accuracy and prognostic value. Left atrial strain assessment has become a novel imaging method in cardiology with superior prognostic value compared to conventional left atrial volume indices. Left atrial function is divided into three phases, reservoir function being the most important. This review summarizes the added value of speckle tracking echocardiography derived left atrial strain assessment in clinical practice. Recently published data suggest the prognostic value of left atrial reservoir function in heart failure, atrial fibrillation, stroke and valvular heart disease. Furthermore, left atrial reservoir strain proved to be a predictor of cardiovascular morbidity and mortality in the general population. Thus, routine assessment of left atrial function can be an optimal strategy to improve cardiovascular risk prediction and supplement the current risk prediction models.

8.
Chest ; 162(4 Supplement):A2106-A2107, 2022.
Article in English | EMBASE | ID: covidwho-2060900

ABSTRACT

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Atypia is common on biopsy specimens of peripheral pulmonary lesions (PPLs) and may result from inflammation or inadequate sampling of a malignancy. The significance of atypical cells on PPLs biopsies has not been well described. In addition, recent studies of navigational bronchoscopy have variably considered atypia on biopsies as diagnostic. METHOD(S): We analyzed a prospective database of consecutive PPLs sampled via navigational bronchoscopy at our institution (IRB: 212187). Search terms "atypia" and "atypical" were applied to pathology reports generated by these procedures. Manual inspection ensured atypia was present in the PPL itself. Definitive PPL diagnosis was established during a two-year routine clinical follow-up. Bronchoscopy diagnostic yield was defined as histopathological findings which readily explained a nodule (malignancy, organizing pneumonia, frank purulence, granulomatous inflammation) and permitted management of the patient without an immediate additional diagnostic intervention. Atypia was considered nonspecific and, therefore, nondiagnostic. RESULT(S): From 11/2017 to 4/2019, 461 biopsied PPLs were identified. Eleven cases, none exhibited atypia, lacked complete two-year follow-up, and were excluded. Ultimately, 274 of 450 (61%) analyzed PPLs were malignant. Diagnostic biopsies were obtained in 331 (73.5%) cases. Atypical cells were present in 33 PPLs (7% of overall cohort, 28% of the 119 nondiagnostic cases). Two-thirds (22 of 33) were eventually determined to be malignant. Lung adenocarcinoma was the most common ultimate malignant diagnosis (10 cases). Most benign PPLs with atypia regressed on follow-up imaging without further pathological data (5 cases). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of atypia for an eventual diagnosis of malignancy among the 223 PPLs not diagnosed as malignant at index bronchoscopy were 46% (95% CI 31-61%), 94% (89-97%), 92% (85-96%), and 53% (46-60%), respectively, with positive likelihood ratio (+LR) of 7.3 (3.8-14). CONCLUSION(S): The presence of atypical cells was a common finding, found in 28% of PPLs without a specific diagnosis after bronchoscopy. Two-thirds of PPLs with atypia were ultimately malignant, with a high PPV (92%) for malignant diagnosis in this cohort with an overall prevalence of malignancy of 61%. CLINICAL IMPLICATIONS: Atypia not diagnostic of malignancy in bronchoscopic biopsy specimens is a nonspecific finding, which may be due to inadequate sampling of a malignant PPL or inflammation. However, the high PPV and +LR of atypia for ultimate malignant PPL diagnosis suggest that in populations with a similar prevalence of malignancy and/or in the clinical context of a high pre-test probability of malignancy, atypical findings might prompt repeat biopsy or definitive PPL management (resection or ablation). DISCLOSURES: No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

9.
Chest ; 162(4 Supplement):A2087-A2088, 2022.
Article in English | EMBASE | ID: covidwho-2060897

ABSTRACT

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: A variety of endpoints have been used to evaluate the diagnostic performance of navigational bronchoscopy for sampling peripheral pulmonary lesions (PPLs), including diagnostic yield (rate of biopsies with a specific diagnosis that facilitates clinical decisions) and diagnostic accuracy (yield plus a follow-up to assess for false negative/positive initial results). There is also significant variation in what non-malignant findings are considered diagnostic, especially regarding nonspecific inflammatory changes. We hypothesized a diagnostic yield definition excluding nonspecific findings as diagnostic would lead to few false negative PPL biopsies. METHOD(S): Our center maintains a prospective cohort of consecutive PPLs targeted via navigational bronchoscopy. Diagnostic yield was defined as specific findings readily explaining the presence of a PPL (malignancy, organizing pneumonia, granulomatous inflammation, frank purulence, other specific finding) permitting management without immediate additional diagnostic intervention. "Other specific finding" required pulmonologist and lung pathologist agreement. All other findings were considered non-diagnostic. RESULT(S): A total of 450 PPLs biopsied 2017-2019 with complete two-year follow-up were included in the analysis. Ultimately, 274 of 450 (60.9%) PPLs were determined to be malignant. Diagnostic biopsies were obtained in 331 cases (73.6%). There was a single false-positive among 228 malignant biopsies (0.4%, carcinoid tumor on cytopathology, alveolar adenoma on resection surgical pathology). Among 223 PPLs without malignant diagnosis at initial bronchoscopy, 48 were later determined to be malignant. Most (n=39) exhibited nonspecific abnormalities on initial pathology. Two of 104 specific benign biopsies were false negative (1.9%). Both demonstrated organizing pneumonia on initial pathology but re-biopsy months after index bronchoscopy revealed Hodgkin's lymphoma and metastatic renal cell carcinoma, respectively. The sensitivity, specificity, and positive predictive value of specific benign findings for an ultimately benign nodule were 58% (95% CI, 51-66%), 95% (86-99%), and 90% (70-97%). The sensitivity, specificity, and positive predictive value of nonspecific benign findings for an ultimately benign PPL diagnosis were 32% (95% CI, 25-39%), 19% (9-33%), and 20% (16-24%). CONCLUSION(S): A definition of diagnostic yield excluding nonspecific benign findings had low false positive/negative rates. If bronchoscopy is not diagnostic of malignancy, a specific benign finding was highly predictive of an ultimately benign PPL, while nonspecific findings poorly predicted benignity. CLINICAL IMPLICATIONS: This definition of diagnostic yield could be used as the primary outcome in future studies, permitting distribution of reliable diagnostic results without requiring years of follow-up. DISCLOSURES: No relevant relationships by Joyce Johnson No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

10.
Chest ; 162(4):A812, 2022.
Article in English | EMBASE | ID: covidwho-2060695

ABSTRACT

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Despite efforts for racial equality, racial disparities are evident in intensive care units. Numerous studies have demonstrated that Non-White patients have higher rates of sepsis, acute kidney injury, and overall mortality throughout different hospital settings. Mechanical ventilation is a common ICU intervention that has multiple associated complications. Prolonged mechanical ventilation (PMV) has been shown to have increased morbidity and resource utilization. In this study, we hypothesized that Non-White patients would experience PMV at higher rates than White patients. METHODS: The analysis cohort was filtered from de-identified administration registry containing inpatients admitted across a diverse five hospital health system between the years 2014 and 2021. Encounters coinciding with surges in COVID-19 were removed. The study group included discharged inpatients that were 18 years or older and experienced mechanical ventilation during their hospital stay. Prolonged mechanical ventilation (PMV) was defined as mechanical ventilation lasting 21 days or longer in accordance with the Centers for Medicare and Medicaid Services (CMS) definition. Univariate analysis was performed to compare characteristics and outcomes across racial identities. Multivariate logistic regression was completed regarding PMV allowing adjustment for confounding variables and assessment of the independent predictive value of racial identity. The analysis was deemed exempt from IRB review, and was performed using R in R-Studio, p-value ≤0.05 was considered significant. RESULTS: The compiled dataset resulted in 8917 mechanical ventilation cases. Of the 8917 cases, 338 patients experienced prolonged mechanical ventilation. The overall rate of PMV was 4%. There were 176/5987 (2.9%) White patients and 162/2930 (5.5%) Non-white patients that had prolonged mechanical ventilation (p<.001). Specifically for Black patients, logistic regression utilized all significant univariate variables confirmed the independent predictive value multivariate OR of 1.62. Additionally, Non-White patients with PMV had on average longer ICU length of stay and were less likely to be discharged to Hospice. CONCLUSIONS: There has been considerable research in identifying marginalized heath care of Non-white patients throughout the hospital. In the ICU, we looked to identify prolonged mechanical ventilation as it’s associated with numerous deleterious outcomes such as sepsis and delirium. A multihospital single system evaluation identified 338 cases of prolonged mechanical ventilation. Following data analysis, Non-White patients were nearly twice the risk of experiencing PMV as compared to White patients. Further investigation into the specific factors is still needed to reduce racial disparities in mechanical ventilation. CLINICAL IMPLICATIONS: Identification of racial disparities, rates of prolonged mechanical ventilation, and length of stay in the ICU. DISCLOSURES: No relevant relationships by David Barbat No relevant relationships by Camden Gardner

11.
Chest ; 162(4):A365, 2022.
Article in English | EMBASE | ID: covidwho-2060575

ABSTRACT

SESSION TITLE: Critical Care Presentations of TB SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: TNFα plays a pivotal role in inflammation and maintenance of immune response against tuberculosis. The use of TNF inhibitors (TNFi) is associated with a significant increase in the incidence of tuberculosis (TB). TNFi may cause drug-induced lupus (ATIL) presenting as constitutional symptoms, rashes, pericardial and pleural effusions with positive autoantibodies. We present a case of pleural TB masquerading as drug-induced lupus. CASE PRESENTATION: A 68y/o woman with a history of ulcerative colitis (on infliximab, mesalamine), hypertension, T2DM, CAD, complained of low-grade fever, rashes, left-sided chest pain, dyspnea, and arthralgias for two weeks. Chest pain- worse with inspiration and cough. She emigrated from India to the USA 40 years ago. Six months before infliximab therapy, Quantiferon gold was negative. Exam: faint hyperpigmentation over shins, minimal swelling of MCPs and ankles, dullness to percussion over the left chest with decreased breath sounds. Labs: CRP 101 mg/dL, Hb 10.8 iron deficient, rheumatoid factor and anti-CCP negative, ANA 1:40, dsDNA 1:640, a reminder of ENA negative, anti-histone negative, C3/C4 normal, UA bland, protein/Cr 0.4 mg/gm, negative blood cultures, SPEP and LDH normal. CXR: opacification of the left lung up to midfield. CT chest: moderate left and small right pleural effusions, enlarged mediastinal lymph nodes. COVID and Quantiferon: negative. Thoracentesis: 850 ml of exudative fluid (2 out of 3 Light's criteria), lymphocytic predominance (76% of 4148 nucleated cells), adenosine deaminase (ADA) 42 U/L, gram stain, culture, acid-fast and MTB PCR negative, cytology negative. Thoracoscopy with biopsy of the parietal pleura: necrotizing granulomatous pleuritis with acid-fast bacilli. Sensitivity: pan-sensitive M. tuberculosis. Sputum: negative for TB. She was discharged on RIPE treatment for reactivation of TB. DISCUSSION: The incidence of infliximab-induced lupus is approximately 0.19% and confirming the diagnosis is challenging. The immunogenicity of infliximab is high, 66% of patients develop positive ANA. Anti-histone antibodies are less commonly associated with ATIL as opposed to classic drug-induced lupus and dsDNA is positive in up to 90% of cases of ATIL. Renal involvement is rare. The diagnostic usefulness of ADA (over 40 U/L) in lymphocytic pleural effusions for the diagnosis of tuberculosis in an immunosuppressed individual is demonstrated here. In countries with low TB burden, such as the USA, the positive predictive value of ADA in pleural fluid declines but the negative predictive value remains high. CONCLUSIONS: Tuberculous pleuritis is not always easily diagnosed since AFB smears and sputum may remain negative. When ADA level in lymphocytic pleural fluid is not low thorough search for TB with thoracoscopy and biopsy is justified. Reference #1: Shovman O, Tamar S, Amital H, Watad A, Shoenfeld Y. Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature. Clin Rheumatol. 2018 Feb;37(2):563-568. Reference #2: Benucci, M., Gobbi, F. L., Fossi, F., Manfredi, M. & Del Rosso, A. (2005). Drug-Induced Lupus After Treatment With Infliximab in Rheumatoid Arthritis. JCR: Journal of Clinical Rheumatology, 11 (1), 47-49. Reference #3: Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Alvarez-Dobaño JM, Sahn SA. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med. 2010 Aug;104(8):1211-7. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Zinobia Khan No relevant relationships by Milena Vukelic

12.
Investigative Ophthalmology and Visual Science ; 63(7):1381-A0077, 2022.
Article in English | EMBASE | ID: covidwho-2058693

ABSTRACT

Purpose : Age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma are vision-threatening diseases (VTDs) affecting 36 million people in the USA. With 5.7 ophthalmologists per 100,000 Americans, over 50% of VTDs go undetected. We assessed deep learning Artificial Intelligence (DLAI) in VTD detection in community and clinical settings. Methods : 223 subjects (mean age 54.6, 58% male) from community screenings (A) and clinic (B) underwent 45-degree retinal imaging. In A (non-dilated), an onsite telemedicine reader (R1) and remote ophthalmologist (R2) graded image quality (gamma and alignment, 1-5 scale) and referable VTD using the international grading scales for AMD and DR, and cup-to-disc ratio and nerve fiber layer for glaucoma. In B (dilated), gradings were collected from R1 and the clinical diagnosis (d). A senior ophthalmologist (R3) adjudicated disputed findings. In A, DLAI VTD referral was compared to R1/R2/R3 consensus (S);in B, overall referral was compared to R1/d/R3 consensus (C). Images were uploaded to a cloud-based DLAI (SELENA+, EyRIS Pte Ltd) (Fig 1). Cohen's kappa assessed intergrader agreement. Results : R1 and R2 found 4.7% eyes ungradable. DLAI marked 55.6% ungradable;74.6% of them were for AMD. Of the DLAI ungradable eyes, image quality was ≤ 3, and 56.2% had ≥ 1+ cataract (R1). Compared to in A, in B DLAI had higher sensitivity (97.1% vs. 63.2%) and positive predictive value (69.4% vs. 32%). In A, DLAI had higher specificity (94.5% vs.16.7%) and negative predictive value (98.4% vs. 75.0%) (Table 1). In A, Cohen's kappa was 0.946 between R1 and R2, with a 13% disagreement rate. In 56% of the disagreements, R3 agreed with R1. In B, Cohen's kappa was 0.874 for R1 and d;R1 referred more than d. In A and B, DLAI referred more than R1, R2, and H/C. DLAI referred all eyes with > 1 VTD (1%) for further examination. Grading times for DLAI, R1, and R2 were 30, 129, and 68 seconds. Conclusions : DLAI performed best in DR and glaucoma detection;a potential solution for the high ungradable rate can be for DLAI to re-center uploaded images. DLAI can increase efficiency and accessibility of screenings for multiple VTDs, in both underserved populations and clinic. The ability to minimize direct contact confers an advantage during COVID-19. Further studies will investigate DLAI use in VTD progression.

13.
Journal of Modern Laboratory Medicine ; 36(5):105-109, 2021.
Article in Chinese | GIM | ID: covidwho-2055553

ABSTRACT

The article's objective was to assess the clinical diagnostic utility of plasma levels of CRP, PCT, and IL-6 in individuals with COVID-19 both alone and in combination. Results showed that according to the ROC curve, PCT and CRP were highly valuable in the diagnosis of COVID-19, and CRP was most valuable in the evaluation of patients with severe and critical COVID-19. The combined detection of the three indexes might increase the evaluation's effectiveness. When evaluating COVID-19 patients who were in severe condition, IL-6 demonstrated a strong predictive value. Therefore, combining the three indicators may increase the diagnostic efficiency and provide crucial reference values for the clinical diagnosis and treatment of COVID-19. CRP, PCT, and IL-6 levels may be potential biomarkers for the diagnosis of COVID-19 and can be used to determine the severity of COVID-19.

14.
Journal of Modern Laboratory Medicine ; 36(4):122-128, 2021.
Article in Chinese | GIM | ID: covidwho-2055552

ABSTRACT

The aim this meta-analaysis was to understand the current status of nucleic acid positivity rate of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in close contacts of novel coronavirus-infected patients in China. The literature related to SARS-CoV-2 nucleic acid testing in close contacts of novel coronavirus-infected patients in China was searched in PubMed, EMbase, China Journal Full-text Data Base (CNKI), Wanfang Science and Technology Journal Full-text Database, and Veep Chinese Science and Technology Journal Full-text Database (VIP) from December 2019 to December 2020. 24 December 2019-2020. The quality of the literature was evaluated with reference to the revised American Agency for Healthcare Research and Quality (AHRQ) statement. StataSE15.0 software was used for meta-analysis, combined positive rates were calculated using the Freeman-Tukey double inverse sine conversion method, subgroup analysis was performed according to sex, age, infected person relationship, mode of infection and frequency of exposure, and sensitivity analysis and Egger's method was used to test for publication bias. Results A total of 11 publications were included, with a total sample size of 24 906 cases. The SARS-CoV-2 nucleic acid positivity rate in the close contact population of novel coronavirus-infected patients was 5.42% (95% CI: 3.57%-7.64%), and subgroup analysis showed that the positivity rate was 4.35% in males and 6.36% in females;the positivity rate was 5.88% in the 0-9 years group and 4.76% in the 10-59 years group. The positive rates were 5.88% for the 0-9 years group, 4.76% for the 10-59 years group and 8.73% for the =60 years group;13.42% for family members and 2.09% for others;11.44% for people living together, 9.90% for meals and 1.95% for other modes of infection;and 1.32%, 6.12% and 9.60% for occasional, normal and frequent contacts, respectively. The differences between the subgroups were statistically significant (?2 = 37.89 to 809.90, all P < 0.05). The sensitivity analysis suggested stable results and the Egger's test for publication bias was not statistically significant (t=0.93, P=0.376). Conclusion Close contacts of novel coronavirus-infected individuals in the Chinese region have a positive rate for SARS-CoV-2 nucleic acid.

15.
Journal of Modern Laboratory Medicine ; 36(3):103-107, 2021.
Article in Chinese | GIM | ID: covidwho-2055550

ABSTRACT

This study aimed to evaluate the application and diagnostic efficacy of two different colloidal gold kits for the detection of 2019-nCoV immunoglobulin M antibody (anti-IgM) and immunoglobulin G antibody (anti-IgG) in Beijing, a low endemic area, and to guide the rational clinical application. The sera of 29 patients with confirmed novel coronavirus pneumonia (COVID-19) and 19 411 patients from the non-infected screening population were selected to evaluate the sensitivity, specificity and false-positive rate of the 2019-nCoV antibody test kits from Zhuhai Lizhu and Tangshan Innotek using colloidal gold immunochromatography. The sensitivity of Inotec 2019-nCoV was slightly higher than that of Lizhu 2019-nCoV, with a sensitivity of 58.62% and 55.17%, respectively;the specimen collection time of the all-negative group was significantly less than that of the antibody-positive group (P < 0.05);the false-positive rate of the two reagents in the low-prevalence area was 0.16%, and the false-positive rate of 2019-nCoV IgG was higher in Inotec than in Lizhu. The false positive rate for 2019-nCoV IgM was significantly higher than that for IgG for the same brand (Inotec ?2=14.756 09, P=0.000 0;Lizhu ?2=27.492 62, P=0.000). Conclusion The 2019-nCoV antibody test is rapid, simple and easy to perform, with high specificity, and can be used as a rapid screening indicator for new crowns;the specificity, correctness and negative predictive value of the two kits are good, and the application of the other kit for retesting when a positive result occurs can reduce the false positive rate of informing the clinic;the application and analysis of positive reports of new crown antibodies should be combined with the endemic area and clinical comprehensive judgment.

16.
Transplantation ; 106(8):143-144, 2022.
Article in English | EMBASE | ID: covidwho-2040900

ABSTRACT

Background: With the highly effective direct-acting antiviral (DAA) therapy, the number of liver transplants for hepatitis C virus (HCV) has decreased worldwide. However, similar to the phenomenon occurring in COVID-19 infection, the residual virus reservoirs in target organ is warranted to be explored due to the potential replication and disease recurrence. Hence, we aim to investigate the significance of hepatic HCV RNA identification as well as the discrepancy between HCV RNA and HCV core antigen (HCV Ag) in native liver of chronic hepatitis C recipients undergoing living donor liver transplantation (LDLT). Methods: Between Feb 2016 to Aug 2019, we prospectively enrolled 80 serum anti-HCV positive recipients who underwent LDLT. HCV RNA extracted from the native liver tissues was subjected to one-step reverse transcribed qPCR, using the TopScript One Step qRT PCR Probe Kit with HCV qPCR probe assay and human GAPDH qPCR probe assay on ViiA 7 Real Time PCR System. Hepatic HCV Ag was identified from the native liver tissues by employing the qualitative enzyme immunoassay technique. All experimental steps were based on the protocol provided by Human HCV Ag ELISA Kit (Cat. No. MBS167758). Results: Among 80 recipients, 85% (68/80) positive HCV-RNA was significantly higher in the native liver tissues than in the serum before (29/80, 36.3%;p = 0.000) and after LDLT (3/80, 4.4%;p = 0.000). In contrast, hepatic HCV Ag was 100% negative identified in all 80 explanted native liver. Conclusions: Significant positive HCV-RNA identification in the native liver suggested that pre-LDLT serum HCV RNA should be underestimated in the real status of HCV activity. HCV Ag assay may have lack of sensitivity and negative predictive value in liver tissues. In contrast to serum HCV RNA and HCV Ag, a great discrepancy might be described between hepatic HCV RNA and HCV Ag in the liver tissue. (Figure Presented).

17.
Signa Vitae ; 18(5):86-94, 2022.
Article in English | CAB Abstracts | ID: covidwho-2040592

ABSTRACT

A few months after the onset of the coronavirus Disease 2019 (COVID-19) pandemic, the worse prognoses of acute myocardial infarction, ischemic and hemorrhagic stroke, and cardiac arrest were reported. This study aimed to investigate the changes in the characteristics and prognoses of these diseases in the emergency department (ED) over a year after pandemic's onset. This was a retrospective observational study. The year 2019 was defined as the pre-period, while the year from February 2020 to January 2021 was defined as the post-period. Adult patients diagnosed with acute myocardial infarction, ischemic stroke, hemorrhagic stroke, or cardiac arrest during the study period were included. The primary outcome was in-hospital mortality. Time series analyses using autoregressive integrated moving average (ARIMA)(p,d,q) model were performed to evaluate the changes between periods. A multivariable logistic regression analysis of factors affecting in-hospital mortality was performed. The proportions of patients with acute myocardial infarction (0.8% vs. 1.1%, p < 0.001), hemorrhagic stroke (1.0%vs. 1.2%, p = 0.011), and cardiac arrest (0.9% vs. 1.1%, p = 0.012) increased in the post-period. The post-period was independently associated with in-hospital mortality in acute myocardial infarction (adjusted odds ratio (aOR) 2.54, 95% confidence interval (95% CI) 1.06-6.08, p = 0.037) and hemorrhagic stroke (aOR 1.74, 95% CI 1.11-2.73, p = 0.016), but not for ischemic stroke or cardiac arrest. Over a year after onset of the COVID-19 pandemic in Korea, the number of patients with acute myocardial infarction, hemorrhagic stroke, and cardiac arrest in the ED increased. An independent association between the post-period and mortality was observed for acute myocardial infarction, and hemorrhagic stroke. This study provides important information for future studies and policies.

18.
Boletin de Malariologia y Salud Ambiental ; 61(Edicion Especial II 2021):70-77, 2021.
Article in Spanish | CAB Abstracts | ID: covidwho-2033961

ABSTRACT

The SARS-CoV-2 that causes the COVID-19 disease, clinically ranges from mild flu-like episodes to other serious and even life-threatening, especially due to acute respiratory failure, regardless of the severity the acute course can be overcome, however, the persistence of symptoms or multi-organ symptom complex, called persistent COVID. Among these persistent symptoms is respiratory distress. A descriptive, observational and cross-sectional study was carried out in 29 people diagnosed with persistent COVID-19 plus comorbidity pulmonary hypertension, between 2019 and 2021. The Borg dyspnea scales were applied at rest and by stress test Walk test in 6;and the Medical Research Council dyspnea scale. IFB B categorizes between 0 and 2 and high R2 (0.7993) explains the perception of respiratory discomfort that appears with activity levels that do not normally cause this type of discomfort (daily activity), and can be weighted by the level of activity necessary for it to be triggered. Both scales have validity, reliability, specificity, sensitivity and predictive value for the use that has been established, easy to use and understand.

19.
Osmaniye Korkut Ata Universitesi Fen Bilimleri Enstitusu Dergisi / Osmaniye Korkut Ata University Journal of Natural and Applied Sciences ; 5(2):505-521, 2022.
Article in English | GIM | ID: covidwho-2026790

ABSTRACT

The infection called Covid-19 caused by the new type of coronavirus (SARS-CoV-2) is an epidemic and deadly disease that spreads rapidly worldwide. Early detection of Covid-19 will enable the patient to receive appropriate treatment and increase the chance of survival. This study aims to investigate the detection of poor prognosis from chest CT images in Covid-19 patients who died and healed using deep learning. In this retrospective study which was carried out in collaboration with a specialist radiologist, a dataset was created by evaluating a total of 5997 CT images by the expert. Images belonging to two classes in the dataset were classified using the Inception-v3 deep learning model. In order to evaluate the classifier, ROC curves were drawn, AUC and accuracy values were used as performance metrics. Inception-v3 model was run 10 times, and a maximum classification performance of 97.55% and an average of 97.01% was achieved. The classification results prove that Inception-v3 can classify CT images with a high accuracy rate for evaluating the Covid-19 prognosis.

20.
J Microbiol Biol Educ ; 23(2)2022 Aug.
Article in English | MEDLINE | ID: covidwho-2019723

ABSTRACT

The classic concepts of sensitivity and specificity are commonly taught by definition only, often with discipline-specific jargon and without any tangible relation to their use in the real world. Yet, the COVID pandemic and the spotlight on diagnostic screening tests have brought a need for science and health care students, health professionals, and the general public to have improved understanding of sensitivity and specificity and how they connect to further interpretive values. These understandings are critical for correct communications and explanations to those outside the sciences. Using simple candies or marbles as visuals, in conjunction with real-world scenarios, this activity was designed to help frame these concepts for students. Additionally, this activity provides practice with basic calculations and interpretations to reinforce how data can be used in determining testing values, surrogate testing, data cutoffs, and accuracy predictions. The activity is flexible and can easily be done in 1 to 2 h in a classroom setting, as a laboratory exercise, or as an outreach or online activity.

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