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The Ultrasound Journal ; 13(1), 2021.
Artículo | WHO COVID | ID: covidwho-1105733


BackgroundAs medical infrastructures are strained by SARS-CoV-2, rapid and accurate screening tools are essential In portions of the world, reverse transcription polymerase chain reaction (RT-PCR) testing remains slow and in limited supply, and computed tomography is expensive, inefficient, and involves exposure to ionizing radiation Multiple studies evaluating the efficiency of lung point-of-care ultrasound (POCUS) have been published recently, but include relatively small cohorts and often focus on characteristics associated with severe illness rather than screening efficacy This study utilizes a retrospective cohort to evaluate the test characteristics (sensitivity, specificity, likelihood ratios, predictive values) of lung POCUS in the diagnosis of SARS-CoV-2, and to determine lung score cutoffs that maximize performance for use as a screening tool ResultsLung POCUS examinations had sensitivity 86%, specificity 71 6%, NPV 81 7%, and PPV 77 7% The Lung Ultrasound Score had an area under the curve of 0 84 (95% CI 0 78, 0 90) When including only complete examinations visualizing 12 lung fields, lung POCUS had sensitivity 90 9% and specificity 75 6%, with NPV 87 2% and PPV 82 0% and an area under the curve of 0 89 (95% CI 0 83, 0 96) Lung POCUS was less accurate in patients with a history of interstitial lung disease, severe emphysema, and heart failure ConclusionsWhen applied in the appropriate patient population, lung POCUS is an inexpensive and reliable tool for rapid screening and diagnosis of SARS-CoV-2 in symptomatic patients with influenza-like illness Adoption of lung POCUS screening for SARS-CoV-2 may identify patients who do not require additional testing and reduce the need for RT-PCR testing in resource-limited environments and during surge periods

JACC Case Rep ; 2(9): 1321-1325, 2020 Jul 15.
Artículo en Inglés | MEDLINE | ID: covidwho-706323


A 58-year-old woman was admitted with symptoms of coronavirus disease-2019. She subsequently developed mixed shock, and an echocardiogram showed mid-distal left ventricular hypokinesis and apical ballooning, findings typical of stress, or takotsubo, cardiomyopathy. Over the next few days her left ventricular function improved, the further supporting the reversibility of acute stress cardiomyopathy. (Level of Difficulty: Beginner.).

Am J Transplant ; 20(8): 2254-2259, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-155106


The novel coronavirus disease 2019 (COVID-19) is a highly infectious and rapidly spreading disease. There are limited published data on the epidemiology and outcomes of COVID-19 infection among organ transplant recipients. After initial flulike symptoms, progression to an inflammatory phase may occur, characterized by cytokine release rapidly leading to respiratory and multiorgan failure. We report the clinical course and management of a liver transplant recipient on hemodialysis, who presented with COVID-19 pneumonia, and despite completing a 5-day course of hydroxychloroquine, later developed marked inflammatory manifestations with rapid improvement after administration of off-label, single-dose tocilizumab. We also highlight the role of lung ultrasonography in early diagnosis of the inflammatory phase of COVID-19. Future investigation of the effects of immunomodulators among transplant recipients with COVID-19 infection will be important.

Anticuerpos Monoclonales Humanizados/uso terapéutico , Infecciones por Coronavirus/complicaciones , Trasplante de Hígado , Neumonía Viral/complicaciones , Diálisis Renal , Receptores de Trasplantes , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/cirugía , Infecciones por Coronavirus/tratamiento farmacológico , Hepatitis C/complicaciones , Hepatitis C/cirugía , Humanos , Hidroxicloroquina/uso terapéutico , Inflamación , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Reoperación , Resultado del Tratamiento