Chest radiological finding of COVID-19 in patients with and without diabetes mellitus: Differences in imaging finding.

The pandemic of novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus is a risk factor for developing severe illness and a leading cause of death in patients with COVID-19. Diabetes can precipitate hyperglycaemic emergencies and cause prolonged hospital admissions. Insulin resistance is thought to cause endothelial dysfunction, alveolar capillary micro-angiopathy and interstitial lung fibrosis through pro-inflammatory pathways. Autopsy studies have also demonstrated the presence of microvascular thrombi in affected sections of lung, which may be associated with diabetes. Chest imaging using x-ray (CXR) and computed tomography (CT) of chest is used to diagnose, assess disease progression and severity in COVID-19. This article reviews current literature regarding chest imaging findings in patients with diabetes affected by COVID-19. A literature search was performed on PubMed. Patients with diabetes infected with SARS-CoV-2 are likely to have more severe infective changes on CXR and CT chest imaging. Severity of airspace consolidation on CXR is associated with higher mortality, particularly in the presence of co-morbidities such as ischaemic heart disease. Poorly controlled diabetes is associated with more severe acute lung injury on CT. However, no association has been identified between poorly-controlled diabetes and the incidence of pulmonary thromboembolism in patients with COVID-19.

Punctate White Matter Lesions Associated With Altered Brain Development And Adverse Motor Outcome In Preterm Infants.

Preterm infants who develop neurodevelopmental impairment do not always have recognized abnormalities on cerebral ultrasound, a modality routinely used to assess prognosis. In a high proportion of infants, MRI detects punctate white matter lesions that are not seen on ultrasonography. To determine the relation of punctate lesions to brain development and early neurodevelopmental outcome we used multimodal brain MRI to study a large cohort of preterm infants. Punctate lesions without other focal cerebral or cerebellar lesions were detected at term equivalent age in 123 (24.3%) (59 male) of the 506 infants, predominantly in the centrum semiovale and corona radiata. Infants with lesions had higher gestational age, birth weight, and less chronic lung disease. Punctate lesions showed a dose dependent relation to abnormalities in white matter microstructure, assessed with tract-based spatial statistics, and reduced thalamic volume (p < 0.0001), and predicted unfavourable motor outcome at a median (range) corrected age of 20.2 (18.4-26.3) months with sensitivity (95% confidence intervals) 71 (43-88) and specificity 72 (69-77). Punctate white matter lesions without associated cerebral lesions are common in preterm infants currently not regarded as at highest risk for cerebral injury, and are associated with widespread neuroanatomical abnormalities and adverse early neurodevelopmental outcome.

Assessing fracture risk in people with MS: a service development study comparing three fracture risk scoring systems.

OBJECTIVES: Suboptimal bone health is increasingly recognised as an important cause of morbidity. Multiple sclerosis (MS) has been consistently associated with an increased risk of osteoporosis and fracture. Various fracture risk screening tools have been developed, two of which are in routine use and a further one is MS-specific. We set out to compare the results obtained by these in the MS clinic population. DESIGN: This was a service development study. The 10-year risk estimates of any fracture and hip fracture generated by each of the algorithms were compared. SETTING: The MS clinic at the Royal London Hospital. PARTICIPANTS: 88 patients with a confirmed diagnosis of MS. OUTCOME MEASURES: Mean 10-year overall fracture risk and hip fracture risk were calculated using each of the three fracture risk calculators. The number of interventions that would be required as a result of using each of these tools was also compared. RESULTS: Mean 10-year fracture risk was 4.7%, 2.3% and 7.6% using FRAX, QFracture and the MS-specific calculator, respectively (p<0.0001 for difference). The agreement between risk scoring tools was poor at all levels of fracture risk. CONCLUSIONS: The agreement between these three fracture risk scoring tools is poor in the MS population. Further work is required to develop and validate an accurate fracture risk scoring system for use in MS. TRIAL REGISTRATION: This service development study was approved by the Clinical Effectiveness Department at Barts Health NHS Trust (project registration number 156/12).