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1.
BMC Infect Dis ; 21(1): 192, 2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1090689

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused a global pandemic that has raised worldwide concern. This study aims to investigate the correlation between the extent of lung infection and relevant clinical laboratory testing indicators in COVID-19 and to analyse its underlying mechanism. METHODS: Chest high-resolution computer tomography (CT) images and laboratory examination data of 31 patients with COVID-19 were extracted, and the lesion areas in CT images were quantitatively segmented and calculated using a deep learning (DL) system. A cross-sectional study method was carried out to explore the differences among the proportions of lung lobe infection and to correlate the percentage of infection (POI) of the whole lung in all patients with clinical laboratory examination values. RESULTS: No significant difference in the proportion of infection was noted among various lung lobes (P > 0.05). The POI of total lung was negatively correlated with the peripheral blood lymphocyte percentage (L%) (r = - 0.633, P < 0.001) and lymphocyte (LY) count (r = - 0.555, P = 0.001) but positively correlated with the neutrophil percentage (N%) (r = 0.565, P = 0.001). Otherwise, the POI was not significantly correlated with the peripheral blood white blood cell (WBC) count, monocyte percentage (M%) or haemoglobin (HGB) content. In some patients, as the infection progressed, the L% and LY count decreased progressively accompanied by a continuous increase in the N%. CONCLUSIONS: Lung lesions in COVID-19 patients are significantly correlated with the peripheral blood lymphocyte and neutrophil levels, both of which could serve as prognostic indicators that provide warning implications, and contribute to clinical interventions in patients.


Asunto(s)
/diagnóstico por imagen , Pulmón/patología , Aprendizaje Automático , Adulto , Técnicas de Laboratorio Clínico , Estudios Transversales , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/virología , Recuento de Linfocitos , Linfocitos/citología , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Pandemias , Pronóstico , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
3.
Eur Rev Med Pharmacol Sci ; 25(2): 1080-1086, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1081037

RESUMEN

OBJECTIVE: This study aimed to explore the atypical imaging findings of the novel coronavirus pneumonia (COVID-19) and its evolution. MATERIALS AND METHODS: The atypical imaging data of ten patients in our hospital who tested positive for COVID-19 were analyzed retrospectively, and the distribution, morphology, and image evolution of the lesions were analyzed. High-resolution computed tomography (HRCT) was performed in all cases, and the imaging features were analyzed and summarized by two senior radiologists. RESULTS: Of these ten patients, three were male, and seven were female. The age of these patients ranged from 21-53 years, with an average age of 36.3 ± 3.6. The first symptom was fever in nine cases and dry cough in one case. A total of 17 lesions were detected in these ten patients. Five patients had a single lesion, and five patients had multiple lesions, for a total of 12 lesions. Ten lesions (58.82%) were located in the inferior lobe of the right lung, four lesions (23.53%) in the left inferior lobe, two lesions (11.76%) in the left upper lobe, and one lesion (5.88%) in the right middle lobe. Among the five single lesions, two were solid lesions, two were mixed ground-glass lesions, and one was a pure ground-glass lesion. Among the 12 multiple lesions, eight were solid lesions, two were mixed ground-glass lesions, and two were pure ground-glass lesions. Atypical manifestations in image signs: five lesions (29.41%) had single solid and sub-solid nodules, and four lesions (23.53%) had cavitary nodules. Typical manifestation (the presence of "white lung"): three lesions (17.65%) had an air bronchogram, two lesions (11.76%) had crazy-paving signs, two lesions (11.76%) had vascular thickening, and one lesion (5.88%) had halo signs. At reexamination 2-6 days later, 15 lesions (88.24%) had enlarged or increased, and two lesions (11.76%) had decreased or absorbed. CONCLUSIONS: Patients with COVID-19 may have atypical imaging findings. Radiologists should improve their understanding of the novel coronavirus pneumonia to avoid any missed diagnoses.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/tendencias , Adulto Joven
4.
BMJ Case Rep ; 14(2)2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1080449

RESUMEN

COVID-19 mainly causes pulmonary disease. Involvement of gastrointestinal and hepatobiliary systems, among other systems, has been reported. We report a case of acute pancreatitis in a patient with resolving COVID-19 pneumonia. History taking and investigations excluded other causes of pancreatitis. This case demonstrates the possibility of pancreatic injury in patients with COVID-19, in line with previously reported similar cases. We believe that it is imperative to screen patients presenting with acute pancreatitis for SARS-CoV-2. It is also important to take into consideration that patients with a complicated course who require an invasive procedure such as drainage might pose a risk of transmission to the operating surgeon or interventionist.


Asunto(s)
/diagnóstico , Pancreatitis/virología , /diagnóstico por imagen , Tratamiento Conservador , Diagnóstico Diferencial , Femenino , Humanos , Pulmón/diagnóstico por imagen , Persona de Mediana Edad , Pancreatitis/diagnóstico por imagen , Pancreatitis/terapia , Tomografía Computarizada por Rayos X
5.
BMC Infect Dis ; 21(1): 167, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1079217

RESUMEN

BACKGROUND: Characteristics of COVID-19 patients have mainly been reported within confirmed COVID-19 cohorts. By analyzing patients with respiratory infections in the emergency department during the first pandemic wave, we aim to assess differences in the characteristics of COVID-19 vs. Non-COVID-19 patients. This is particularly important regarding the second COVID-19 wave and the approaching influenza season. METHODS: We prospectively included 219 patients with suspected COVID-19 who received radiological imaging and RT-PCR for SARS-CoV-2. Demographic, clinical and laboratory parameters as well as RT-PCR results were used for subgroup analysis. Imaging data were reassessed using the following scoring system: 0 - not typical, 1 - possible, 2 - highly suspicious for COVID-19. RESULTS: COVID-19 was diagnosed in 72 (32,9%) patients. In three of them (4,2%) the initial RT-PCR was negative while initial CT scan revealed pneumonic findings. 111 (50,7%) patients, 61 of them (55,0%) COVID-19 positive, had evidence of pneumonia. Patients with COVID-19 pneumonia showed higher body temperature (37,7 ± 0,1 vs. 37,1 ± 0,1 °C; p = 0.0001) and LDH values (386,3 ± 27,1 vs. 310,4 ± 17,5 U/l; p = 0.012) as well as lower leukocytes (7,6 ± 0,5 vs. 10,1 ± 0,6G/l; p = 0.0003) than patients with other pneumonia. Among abnormal CT findings in COVID-19 patients, 57 (93,4%) were evaluated as highly suspicious or possible for COVID-19. In patients with negative RT-PCR and pneumonia, another third was evaluated as highly suspicious or possible for COVID-19 (14 out of 50; 28,0%). The sensitivity in the detection of patients requiring isolation was higher with initial chest CT than with initial RT-PCR (90,4% vs. 79,5%). CONCLUSIONS: COVID-19 patients show typical clinical, laboratory and imaging parameters which enable a sensitive detection of patients who demand isolation measures due to COVID-19.


Asunto(s)
/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Alemania/epidemiología , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Tomografía Computarizada por Rayos X , Adulto Joven
6.
Viruses ; 13(1)2020 12 30.
Artículo en Inglés | MEDLINE | ID: covidwho-1073492

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (COVID-19), a lung disease that may progress to systemic organ involvement and in some cases, death. The identification of the earliest predictors of progressive lung disease would allow for therapeutic intervention in those cases. In an earlier clinical study, individuals with moderate COVID-19 were treated with either arbidol (ARB) or inhaled interferon (IFN)-α2b +/-ARB. IFN treatment resulted in accelerated viral clearance from the upper airways and in a reduction in the circulating levels of the inflammatory biomarkers IL-6 and C-reactive protein (CRP). We have extended the analysis of this study cohort to determine whether IFN treatment had a direct effect on virus-induced lung abnormalities and also to ascertain whether any clinical or immune parameters are associated with worsening of lung abnormalities. Evidence is provided that IFN-α2b treatment limits the development of lung abnormalities associated with COVID-19, as assessed by CT images. Clinical predictors associated with worsening of lung abnormalities include low CD8+ T cell numbers, low levels of circulating albumin, high numbers of platelets, and higher levels of circulating interleukin (IL)-10, IL-6, and C-reactive protein (CRP). Notably, in this study cohort, IFN treatment resulted in a higher percentage of CD8+ T cells, lower tumor necrosis factor (TNF)-α levels and, as reported earlier, lower IL-6 levels. Independent of treatment, age and circulating levels of albumin and CRP emerged as the strongest predictors of the severity of lung abnormalities.


Asunto(s)
Antivirales/uso terapéutico , Interferón-alfa/uso terapéutico , Pulmón/anomalías , Administración por Inhalación , Antivirales/administración & dosificación , Biomarcadores/sangre , Proteína C-Reactiva , Linfocitos T CD8-positivos , China , Estudios de Cohortes , Citocinas/inmunología , Quimioterapia Combinada , Humanos , Indoles/administración & dosificación , Indoles/uso terapéutico , Interferón-alfa/administración & dosificación , Interleucina-10 , Interleucina-6 , Pulmón/diagnóstico por imagen , Pulmón/patología , /efectos de los fármacos
7.
BMC Infect Dis ; 21(1): 157, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1069549

RESUMEN

BACKGROUND: Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. METHODS: This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. RESULTS: Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. CONCLUSIONS: Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.


Asunto(s)
/diagnóstico , Pulmón/diagnóstico por imagen , Adulto , Proteína C-Reactiva/metabolismo , Estudios Transversales , Femenino , Humanos , Italia , Pulmón/patología , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
8.
BMC Infect Dis ; 21(1): 155, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1069544

RESUMEN

BACKGROUND: The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. METHODS: Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. RESULTS: Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). CONCLUSIONS: The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.


Asunto(s)
/fisiopatología , Adulto , Anciano , Preescolar , China , Comorbilidad , Tos , Brotes de Enfermedades , Femenino , Fiebre , Hospitalización , Humanos , Lactante , Pulmón/diagnóstico por imagen , Linfopenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
9.
J Coll Physicians Surg Pak ; 31(1): 14-20, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1068267

RESUMEN

OBJECTIVE:   To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. STUDY DESIGN: Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. METHODOLOGY: Five hundred suspected COVID-19 cases referred for high resolution computed tomography - chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per 'Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection' recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. RESULTS: Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. CONCLUSION: In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. Key Words: COVID-19, COVID-19 pneumonia, CT-SS, High resolution computed tomography.


Asunto(s)
Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pakistán , Radiografía Torácica/métodos , Atención Terciaria de Salud , Adulto Joven
10.
Dan Med J ; 68(2)2021 01 07.
Artículo en Inglés | MEDLINE | ID: covidwho-1063690

RESUMEN

INTRODUCTION: Tools to quickly triage and evaluate patients with suspected COVID-19 in an emergency department (ED) can improve patient care and reduce risk of overcrowding. The aim of this study was to evaluate if lung ultrasound (LUS) may provide valuable prognostic information in adult patients suspected of COVID-19. METHODS: A prospective cohort study of adult patients in an ED was conducted. LUS was performed within one hour of the patients' arrival; COVID-19 was defined by a respiratory syndrome coronavirus 2 RNA positive test. The primary outcome was the proportion of patients suspected of COVID-19 and normal LUS with critical outcomes during follow-up, defined as one or more of the following: need of non-invasive ventilation (NIV), invasive mechanical ventilation, intensive care unit (ICU) stay or death. Follow-up was 14 days. RESULTS: A total of 83 patients were included between 9 March and 12 April 2020. In all, 47 (57%; 95% confidence interval (CI): 45.3-67.5%) had a normal LUS, 46 (98%; 95% CI: 88.7-99.9%) of whom had no critical outcomes. A total of 36 (43%; 95% CI: 32.5-54.7%) had an abnormal LUS, eight of whom (22%; 95% CI: 10.1-39.2%) had critical outcomes. Nine (11%; 95%: CI 5.1-19.6%) had one or more critical outcomes: three on NIV, five in ICUs, four on invasive mechanical ventilation and two died. Among the 12 patients (14%; 95% CI: 7.7-23.9%) tested positive for COVID-19, 11 (92%; 95% CI: 61.5-99.8%) had an abnormal LUS. CONCLUSIONS: Among adult ED patients suspected of COVID-19, a normal LUS is associated with a low risk of critical outcomes. LUS might be considered for routine use as a prognostic tool in patients suspected of COVID-19. FUNDING: none. TRIAL REGISTRATION: not relevant.


Asunto(s)
/diagnóstico , Pulmón/diagnóstico por imagen , Triaje/métodos , Anciano , Estudios de Casos y Controles , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Medición de Riesgo , Tomografía Computarizada por Rayos X , Ultrasonografía
11.
Iran J Allergy Asthma Immunol ; 19(5): 471-477, 2020 Oct 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1068113

RESUMEN

The emergence of a highly pathogenic virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) accounts for severe pneumonia throughout the world. More than 7 million world population have been infected with SARS-CoV-2, and the number of deaths is increasing every day. This study aimed to evaluate the frequency of SARS-CoV-2 in hospitalized patients with an acute respiratory infection (ARI). During an outbreak of the SARS-CoV-2, the nasopharyngeal and oropharyngeal swabs were collected from 909 hospitalized patients with severe pneumonia, including 517 (56.9%) males and 392 (43.1%) females. All the collected samples were from different cities of Khuzestan province from 19 February to- 27 March 2020. The RNA was extracted from samples and subjected to real-time polymerase chain reaction (PCR) tests for the detection of the SARS-CoV-2. Simultaneously, the computerized tomography (CT) scan was tested for the presence of ground-glass opacity in the lung among the patients. Of the total number of 909 specimens, 328 (36.08%) cases, including 185 (20.35%) females and 143 (15.73%) males, were positive for the SARS-CoV-2 while, 581 (63.9%) cases, including 374 (41.14%) males and 207 (22.77%) were negative for the SARS-CoV-2 by real-time PCR (p=0.001).Four hundred sixteen (45.76%) cases were positive for ground-glass opacity in the lung by CT scan, while 328/909 (36.08%) trials proved positive for SARS-CoV-2 by the real-time PCR (p=0.003).  In this study, 36.08% of patients were positive for SARS-CoV-2. Although the results of positive cases by CT scan showed higher than real-time PCR, screening the SARS-COV-2 with a real-time PCR method is the first line of choice.


Asunto(s)
/epidemiología , Hospitalización , Pulmón/diagnóstico por imagen , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/metabolismo , Niño , Preescolar , Femenino , Humanos , Lactante , Irán/epidemiología , Linfopenia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Prevalencia , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Adulto Joven
12.
Am J Case Rep ; 22: e928421, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1068018

RESUMEN

BACKGROUND High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high-frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). CASE REPORT Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. CONCLUSIONS The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.


Asunto(s)
/terapia , Ventilación de Alta Frecuencia , Anciano , Deterioro Clínico , Tos/terapia , Tos/virología , Disnea/terapia , Disnea/virología , Femenino , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Pulmón/virología , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Insuficiencia Respiratoria/prevención & control , Tomografía Computarizada por Rayos X
13.
J Vis Exp ; (166)2020 12 19.
Artículo en Inglés | MEDLINE | ID: covidwho-1067800

RESUMEN

Segmentation is a complex task, faced by radiologists and researchers as radiomics and machine learning grow in potentiality. The process can either be automatic, semi-automatic, or manual, the first often not being sufficiently precise or easily reproducible, and the last being excessively time consuming when involving large districts with high-resolution acquisitions. A high-resolution CT of the chest is composed of hundreds of images, and this makes the manual approach excessively time consuming. Furthermore, the parenchymal alterations require an expert evaluation to be discerned from the normal appearance; thus, a semi-automatic approach to the segmentation process is, to the best of our knowledge, the most suitable when segmenting pneumonias, especially when their features are still unknown. For the studies conducted in our institute on the imaging of COVID-19, we adopted 3D Slicer, a freeware software produced by the Harvard University, and combined the threshold with the paint brush instruments to achieve fast and precise segmentation of aerated lung, ground glass opacities, and consolidations. When facing complex cases, this method still requires a considerable amount of time for proper manual adjustments, but provides an extremely efficient mean to define segments to use for further analysis, such as the calculation of the percentage of the affected lung parenchyma or texture analysis of the ground glass areas.


Asunto(s)
/diagnóstico por imagen , Imagenología Tridimensional/normas , Pulmón/diagnóstico por imagen , Programas Informáticos/normas , Tomografía Computarizada por Rayos X/normas , /epidemiología , Humanos , Imagenología Tridimensional/métodos , Neumonía/diagnóstico por imagen , Neumonía/epidemiología , Tomografía Computarizada por Rayos X/métodos
14.
Intern Med ; 60(3): 473-477, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1067517

RESUMEN

We experienced two cases of post-intubation laryngotracheal stenosis (PILS) occurring in patients after acute coronavirus disease (COVID)-19 in a relatively narrow time period. The patients required mechanical ventilation for 9 days in one and 28 days in the other. In both cases, the patients were discharged but later developed symptoms of cough and dyspnea, which were later diagnosed as PILS. Persistent cough and dyspnea are common symptoms in both PILS and the recovery phase of severe COVID-19. For this reason, PILS should be considered in the differential diagnosis post-COVID-19 patients. In addition, the prevalence of PILS may be greater than that of other critical diseases in severe COVID-19 patients.


Asunto(s)
/complicaciones , Intubación Intratraqueal/efectos adversos , Estenosis Traqueal/etiología , Adulto , Tos/etiología , Disnea/etiología , Femenino , Humanos , Laringoscopía , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Radiografía Torácica , Respiración Artificial , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/diagnóstico por imagen
15.
PLoS One ; 16(1): e0245547, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1067419

RESUMEN

Endemic human coronaviruses (HCoVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are members of the family Coronaviridae. Comparing the findings of the infections caused by these viruses would help reveal the novel characteristics of SARS-CoV-2 and provide insight into the unique pathogenesis of SARS-CoV-2 infection. This study aimed to compare the clinical and radiological characteristics of SARS-CoV-2 and endemic HCoVs infection in adult hospitalized patients with community-acquired pneumonia (CAP). This study was performed at a university-affiliated tertiary hospital in the Republic of Korea, between January 1, 2015, and July 31, 2020. A total of 109 consecutive patients who were over 18 years of age with confirmed SARS-CoV-2 and endemic HCoVs were enrolled. Finally, 19 patients with SARS-CoV-2 CAP were compared to 40 patients with endemic HCoV CAP. Flu-like symptoms such as cough, sore throat, headache, myalgia, and prolonged fever were more common in SARS-CoV-2 CAP, whereas clinical findings suggestive of bacterial pneumonia such as dyspnea, leukocytosis with left shift, and increased C-reactive protein were more common in endemic HCoV CAP. Bilateral peripherally distributed ground-glass opacities (GGOs) were typical radiologic findings in SARS-CoV-2 CAP, whereas mixed patterns of GGOs, consolidations, micronodules, and pleural effusion were observed in endemic HCoV CAP. Coinfection was not observed in patients with SARS-CoV-2 CAP, but was observed in more than half of the patients with endemic HCoV CAP. There were distinctive differences in the clinical and radiologic findings between SARS-CoV-2 and endemic HCoV CAP. Further investigations are required to elucidate the mechanism underlying this difference. Follow-up observations are needed to determine if the presentation of SARS-CoV-2 CAP changes with repeated infection.


Asunto(s)
/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Anciano , /patología , Estudios de Cohortes , Coinfección/diagnóstico por imagen , Coinfección/epidemiología , Coinfección/patología , Coinfección/virología , Infecciones Comunitarias Adquiridas , Coronavirus/aislamiento & purificación , Enfermedades Endémicas , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Coronavirus del Síndrome Respiratorio de Oriente Medio/aislamiento & purificación , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/patología , Neumonía Viral/virología , Radiografía Torácica/métodos , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tórax/diagnóstico por imagen
16.
PLoS One ; 16(1): e0245518, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1067418

RESUMEN

OBJECTIVES: High-risk CXR features in COVID-19 are not clearly defined. We aimed to identify CXR features that correlate with severe COVID-19. METHODS: All confirmed COVID-19 patients admitted within the study period were screened. Those with suboptimal baseline CXR were excluded. CXRs were reviewed by three independent radiologists and opacities recorded according to zones and laterality. The primary endpoint was defined as hypoxia requiring supplemental oxygen, and CXR features were assessed for association with this endpoint to identify high-risk features. These features were then used to define criteria for a high-risk CXR, and clinical features and outcomes of patients with and without baseline high-risk CXR were compared using logistic regression analysis. RESULTS: 109 patients were included. In the initial analysis of 40 patients (36.7%) with abnormal baseline CXR, presence of bilateral opacities, multifocal opacities, or any upper or middle zone opacity were associated with supplemental oxygen requirement. Of the entire cohort, 29 patients (26.6%) had a baseline CXR with at least one of these features. Having a high-risk baseline CXR was significantly associated with requiring supplemental oxygen in univariate (odds ratio 14.0, 95% confidence interval 3.90-55.60) and multivariate (adjusted odds ratio 8.38, 95% CI 2.43-28.97, P = 0.001) analyses. CONCLUSION: We identified several high-risk CXR features that are significantly associated with severe illness. The association of upper or middle zone opacities with severe illness has not been previously emphasized. Recognition of these specific high-risk CXR features is important to prioritize limited healthcare resources for sicker patients.


Asunto(s)
/diagnóstico por imagen , Adulto , /virología , Estudios de Cohortes , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica/métodos , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos
18.
Am J Forensic Med Pathol ; 42(1): 1-8, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1066484

RESUMEN

ABSTRACT: The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.


Asunto(s)
/mortalidad , Pulmón/patología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Autopsia , Índice de Masa Corporal , Edema Encefálico/patología , Cardiomegalia/patología , Comorbilidad , Trombosis Coronaria/patología , Bases de Datos Factuales , Hígado Graso/patología , Femenino , Patologia Forense , Glomeruloesclerosis Focal y Segmentaria/patología , Hepatomegalia/patología , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Nefroesclerosis/patología , New Mexico/epidemiología , Sobrepeso/epidemiología , Pandemias , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/patología , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/patología , Distribución por Sexo , Streptococcus pneumoniae/aislamiento & purificación , Tomografía Computarizada por Rayos X , Cuerpo Vítreo/química , Imagen de Cuerpo Entero
19.
Sci Rep ; 11(1): 1455, 2021 01 14.
Artículo en Inglés | MEDLINE | ID: covidwho-1065938

RESUMEN

The purpose of this study was to develop a fully-automated segmentation algorithm, robust to various density enhancing lung abnormalities, to facilitate rapid quantitative analysis of computed tomography images. A polymorphic training approach is proposed, in which both specifically labeled left and right lungs of humans with COPD, and nonspecifically labeled lungs of animals with acute lung injury, were incorporated into training a single neural network. The resulting network is intended for predicting left and right lung regions in humans with or without diffuse opacification and consolidation. Performance of the proposed lung segmentation algorithm was extensively evaluated on CT scans of subjects with COPD, confirmed COVID-19, lung cancer, and IPF, despite no labeled training data of the latter three diseases. Lobar segmentations were obtained using the left and right lung segmentation as input to the LobeNet algorithm. Regional lobar analysis was performed using hierarchical clustering to identify radiographic subtypes of COVID-19. The proposed lung segmentation algorithm was quantitatively evaluated using semi-automated and manually-corrected segmentations in 87 COVID-19 CT images, achieving an average symmetric surface distance of [Formula: see text] mm and Dice coefficient of [Formula: see text]. Hierarchical clustering identified four radiographical phenotypes of COVID-19 based on lobar fractions of consolidated and poorly aerated tissue. Lower left and lower right lobes were consistently more afflicted with poor aeration and consolidation. However, the most severe cases demonstrated involvement of all lobes. The polymorphic training approach was able to accurately segment COVID-19 cases with diffuse consolidation without requiring COVID-19 cases for training.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Redes Neurales de la Computación , Fibrosis Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Femenino , Humanos , Masculino
20.
Sci Rep ; 11(1): 858, 2021 01 13.
Artículo en Inglés | MEDLINE | ID: covidwho-1065926

RESUMEN

To compare the performance of artificial intelligence (AI) and Radiographic Assessment of Lung Edema (RALE) scores from frontal chest radiographs (CXRs) for predicting patient outcomes and the need for mechanical ventilation in COVID-19 pneumonia. Our IRB-approved study included 1367 serial CXRs from 405 adult patients (mean age 65 ± 16 years) from two sites in the US (Site A) and South Korea (Site B). We recorded information pertaining to patient demographics (age, gender), smoking history, comorbid conditions (such as cancer, cardiovascular and other diseases), vital signs (temperature, oxygen saturation), and available laboratory data (such as WBC count and CRP). Two thoracic radiologists performed the qualitative assessment of all CXRs based on the RALE score for assessing the severity of lung involvement. All CXRs were processed with a commercial AI algorithm to obtain the percentage of the lung affected with findings related to COVID-19 (AI score). Independent t- and chi-square tests were used in addition to multiple logistic regression with Area Under the Curve (AUC) as output for predicting disease outcome and the need for mechanical ventilation. The RALE and AI scores had a strong positive correlation in CXRs from each site (r2 = 0.79-0.86; p < 0.0001). Patients who died or received mechanical ventilation had significantly higher RALE and AI scores than those with recovery or without the need for mechanical ventilation (p < 0.001). Patients with a more substantial difference in baseline and maximum RALE scores and AI scores had a higher prevalence of death and mechanical ventilation (p < 0.001). The addition of patients' age, gender, WBC count, and peripheral oxygen saturation increased the outcome prediction from 0.87 to 0.94 (95% CI 0.90-0.97) for RALE scores and from 0.82 to 0.91 (95% CI 0.87-0.95) for the AI scores. AI algorithm is as robust a predictor of adverse patient outcome (death or need for mechanical ventilation) as subjective RALE scores in patients with COVID-19 pneumonia.


Asunto(s)
Inteligencia Artificial , /terapia , Respiración Artificial , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Pronóstico , Tomografía Computarizada por Rayos X , Adulto Joven
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