Utility of cardiac bioenzymes in predicting cardiovascular outcomes in SARS-CoV-2.

The relationship between coronavirus disease-19 (COVID-19) and cardiovascular diseases has been an important issue. Therefore, cardiac biomarkers and cardiac imaging have an important place in the diagnostic phase. It is important to know the relationship of biomarkers in COVID-19 so that we can understand the diagnosis of the disease, the predicted course and results after diagnosis.

COVID-19-related cardiomyopathy: Can dual-energy computed tomography be a diagnostic tool?

BACKGROUND: No study on dual energy computed tomography (DECT) has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019 (COVID-19) patients. Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion, and these deficits can be shown via DECT with a perfect interrater agreement. AIM: To assess lung perfusion alterations in COVID-19 patients. To our knowledge, no study using DECT has been performed to evaluate possibly fatal cardiac/ myocardial problems in COVID-19 patients. The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases. METHODS: Two blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association's classification of the segmentation of the left ventricular myocardium. Additionally, intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. Following segment-by-segment analysis, perfusion deficiencies identified on the iodine map pictures on DECT were identified. RESULTS: The study enrolled a total of 87 patients. Forty-two of these individuals were classified as COVID-19 positive, and 45 were classified as controls. Perfusion deficits were identified in 66.6% (n = 30) of the cases. All control patients had a normal iodine distribution map. Perfusion deficits were found on DECT iodine map images with subepicardial (n = 12, 40%), intramyocardial (n = 8, 26.6%), or transmural (n = 10, 33.3%) anatomical locations within the left ventricular wall. There was no subendocardial involvement in any of the patients. CONCLUSION: Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion. These deficits can be shown via DECT with a perfect interrater agreement. Additionally, the presence of perfusion deficit is positively correlated with D-dimer levels.

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Long-term lung perfusion changes related to COVID-19: a dual energy computed tomography study

PURPOSE: Although the findings of acute new coronavirus disease (COVID-19) infection on dual-energy computed tomography (DECT) have recently been defined, the long-term changes in lung perfusion associated with COVID-19 pneumonia have not yet been clarified. We aimed to examine the longterm course of lung perfusion in COVID-19 pneumonia cases using DECT and to compare changes in lung perfusion to clinical and laboratory findings. METHODS: On initial and follow-up DECT scans, the presence and extent of perfusion deficit (PD) and parenchymal changes were assessed. The associations between PD presence and laboratory parameters, initial DECT severity score, and symptoms were evaluated. RESULTS: The study population included 18 females and 26 males with an average age of 61.32 ± 11.3 years. Follow-up DECT examinations were performed after the mean of 83.12 ± 7.1 (80-94 days) days. PDs were detected on the follow-up DECT scans of 16 (36.3%) patients. These 16 patients also had ground-glass parenchymal lesions on the follow-up DECT scans. Patients with persistent lung PDs had significantly higher mean initial D-dimer, fibrinogen, and C-reactive protein values than patients without PDs. Patients with persistent PDs also had significantly higher rates of persistent symptoms. CONCLUSION: Ground-glass opacities and lung PDs associated with COVID-19 pneumonia can persist for up to 80-90 days. Dual-energy computed tomography can be used to reveal long-term parenchymal and perfusion changes. Persistent PDs are commonly seen together with persistent COVID-19 symptoms.

Possible agent for COVID-19 treatment: Rifampicin.

Rifampicin is a promising drug for the treatment of coronavirus disease 2019 based on its antiviral properties and recent in silico studies. In silico studies can serve as a foundation for further studies.

Effect of age on computed tomography findings: Specificity and sensitivity in coronavirus disease 2019 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019. Although the real-time reverse tr-anscription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis, computed tomography (CT) has grown in importance. AIM: To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups. METHODS: PCR and CT results from 411 patients were reviewed. The diagnosis of COVID-19 pneumonia was made by three radiologists. Lymphadenopathy, pericardial effusion, pleurisy, pleural thickening, pleural effusion, location features of the lesions, ground glass, consolidation, air bronchogram, vascular enlargement, bronchial dilatation, halo finding, inverted halo sign, nodularity, air bubble, subpleural band (curvilinear density), reticular density, crazy paving pattern, and fibrosis findings were recorded. The patients were divided into nine groups by decades while calculating the sensitivity, specificity, and diagnostic efficacy for CT positivity. RESULTS: The mean age of the cases was 48.1 ± 22.7 years. The CT finding with the highest diagnostic power was ground glass. Vascular enlargement and bronchial dilatation followed ground glass. Peri-cardial effusion was the finding with the lowest diagnostic accuracy. The incidence of lymphadenopathy, pleurisy, pleural thickening, peripheral localization, bilateral, ground glass, vascular enlargement, bronchial dilatation, subpleural band, reticular density, crazy paving appearance, and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test. CONCLUSION: There are few publications comparing sensitivity and specificity of thoracic CT findings according to age. In cases of COVID-19 pneumonia, there is an increase in the variety and frequency of CT findings with age, and parallel to this the sensitivity and specificity of the findings increase. COVID-19 cases in the pediatric age group have fewer lung findings than adults, and this situation decreases the diagnostic value of CT in pediatric patients.

Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department.

BACKGROUND: The aim of this study was to define clinical evidence supporting that triple rule-out computed tomography angiography (TRO CTA) is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019 (COVID-19) who were admitted to the emergency department (ED) for acute chest pain. Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events, will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects. AIM: To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain, and to assess outcomes of optimizing diagnostic imaging strategies, particularly TRO CTA use, in COVID-19 related thromboembolic events. METHODS: TRO CTA images were evaluated for the presence of coronary artery disease, pulmonary thromboembolism (PTE), or acute aortic syndromes. Statistical analyses were used for evaluation of significant association between the variables. A two tailed P-value < 0.05 was considered statistically significant. RESULTS: Fifty-three patients were included into the study. In 31 patients (65.9%), there was not any pathology, while PTE was diagnosed in 11 patients. There was no significant relationship between the rates of pathology on CTA and history of hypertension. On the other hand, the diabetes mellitus rate was much higher in the acute coronary syndrome group, particularly in the PTE group (8/31 = 25.8% vs 6/16 = 37.5%, P = 0.001). The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group (62.5% vs 38.7%, P < 0.001). Smoking history rates were similar in the groups. Platelets, D-dimer, fibrinogen, C-reactive protein, and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies. CONCLUSION: TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data.

BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID-19 infection and scrotal infection are associated. MATERIALS AND METHODS: Patients with a COVID-19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data. RESULTS: The median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo-orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group. CONCLUSIONS: Even if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID-19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.

Evaluation of thorax computed tomographic findings in COVID-19 variant cases.

BACKGROUND: Because of genetic mutations occurring during viral replication, new SARS-CoV-2 variants will continue to emerge. Throughout the COVID-19 pandemic, thorax computed tomographic (CT) findings have played a crucial role in the diagnosis and follow-up of patients with COVID-19. In this study, we compared the thorax CT findings of patients infected with SARS-CoV-2 variants (variant group) with those of patients infected with the non-variant strain (non-variant group) to assess if thorax CT findings may be utilized to discriminate between the groups. Furthermore, we compared demographic and laboratory data between the groups. METHODS: The study comprised a total of 77 patients who presented to our hospital with a preliminary diagnosis of COVID-19 based on clinical symptoms, a positive oropharyngeal/nasopharyngeal swab RT-PCR testing, and thorax CT examinations. Patients' laboratory and demographic features as well as thorax CT findings were retrospectively evaluated, and the results were grouped according to RT-PCR results. RESULTS: There were 42 patients in the non-variant group and 35 patients in the variant group. The average age of patients infected with the non-variant strain, alpha variant, and gamma variant was 63.52 ± 14.87 years, 54.86 ± 14.31 years, and 59.4 ± 17.79 years, respectively. The average age of the variant group was significantly lower than that of the non-variant group. There was no significant difference in thorax CT findings between the groups, and consolidation, ground glass densities, and cobblestone pattern in the bilateral lower lobes and peripheral areas were the most common thorax CT findings in both the groups. CONCLUSION: There is no significant difference in thorax CT findings between the variant and non-variant groups. Therefore, clinical and laboratory characteristics should take precedence over thorax CT findings for distinguishing between patients infected with SARS-CoV-2 variants and the non-variant strain.

Lung perfusion changes in COVID-19 pneumonia: a dual energy computerized tomography study.

OBJECTIVE: There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings. METHODS: Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant. RESULTS: Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation. CONCLUSIONS: Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity. ADVANCES IN KNOWLEDGE: Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.

Computed tomography at every step: Long coronavirus disease.

BACKGROUND: Some patients continue to experience symptoms related to Coronavirus disease (COVID-19) after the acute phase of infection. Imaging studies, especially computed tomography (CT) of the chest, have gained importance since the beginning of the pandemic. CT can help diagnose COVID-19, assess the extent of pulmonary involvement, and predict the disease severity. We aimed to define the frequency of persistent symptoms and correlate their presence with the results of laboratory findings and the severity of the disease based on the findings of chest CT. METHODS: We examined patients discharged from the hospital after treatment for COVID-19 and whose nasopharyngeal swab sample tested positive for severe acute respiratory syndrome coronavirus 2 after at least 4 weeks from the initial diagnosis. The patients were asked about the presence of persisting symptoms. In addition to the demographic data, laboratory results and severity levels seen on the chest CT were recorded. RESULTS: In all, 116 patients were included in the study, of which 61 reported at least one persisting symptom (52.5%). The mean age of the study population was 48.90 ± 17.74 years. The persistent symptoms included shortness of breath, chest pain, cough, muscle weakness, dizziness, headache, fatigue, and palpitations. The mean CT severity score was 3.80 ± 0.38 and it was lower in patients without any persistent symptoms. CONCLUSIONS: Levels of C-reactive protein and fibrinogen, anemia, and female sex were associated with some of the persistent symptoms., the severity of the disease seen on CT was a successful predictor for the disease severity/prognosis and was also correlated with prolonged COVID infection and more persistent symptoms.