[CT findings in survivors and non-survivors of COVID-19 and clinical usefulness of a CT scoring system]. / Hallazgos tomográficos entre sobrevivientes y no-sobrevivientes con COVID-19 y utilidad clínica de una puntuación de tomografía torácica.

Background: Many patients with coronavirus disease 2019 (COVID-19) have been diagnosed with computed tomography (CT). A prognostic tool based on CT findings could be useful for predicting death from COVID-19. Objectives: To compare the chest CT findings of patients who survived COVID-19 versus those of patients who died of COVID-19 and to determine the usefulness the clinical usefulness of a CT scoring system for COVID-19. Methods: We included 124 patients with confirmed SARS-CoV-2 infections who were hospitalized between April 1, 2020 and July 25, 2020. Results: Whereas ground-glass opacities were the most common characteristic finding in survivors (75%), crazy paving was the most characteristic finding in non-survivors (65%). Atypical findings were present in 46% of patients. The chest CT score was directly proportional to mortality; a score ≥ 18 was the best cutoff for predicting death, yielding 70% sensitivity (95%CI: 47%-87%). Conclusions: Our results suggest that atypical lesions are more prevalent in this cohort. The chest CT score had high sensitivity for predicting hospital mortality.

CT findings in survivors and non-survivors of COVID-19 and clinical usefulness of a CT scoring system.

BACKGROUND: Many patients with coronavirus disease 2019 (COVID-19) have been diagnosed with computed tomography (CT). A prognostic tool based on CT findings could be useful for predicting death from COVID-19. OBJECTIVES: To compare the chest CT findings of patients who survived COVID-19 versus those of patients who died of COVID-19 and to determine the usefulness the clinical usefulness of a CT scoring system for COVID-19. METHODS: We included 124 patients with confirmed SARS-CoV-2 infections who were hospitalized between April 1, 2020 and July 25, 2020. RESULTS: Whereas ground-glass opacities were the most common characteristic finding in survivors (75%), crazy paving was the most characteristic finding in non-survivors (65%). Atypical findings were present in 46% of patients. The chest CT score was directly proportional to mortality; a score ≥18 was the best cutoff for predicting death, yielding 70% sensitivity (95%CI: 47%-87%). CONCLUSIONS: Our results suggest that atypical lesions are more prevalent in this cohort. The chest CT score had high sensitivity for predicting hospital mortality.

Hallazgos tomográficos entre sobrevivientes y no-sobrevivientes con COVID-19 y utilidad clínica de una puntuación de tomografía torácica / CT findings in survivors and non-survivors of COVID-19 and clinical usefulness of a CT scoring system

Antecedentes: Muchos pacientes con enfermedad por coronavirus 2019 (COVID-19) han sido diagnosticados mediante tomografía computarizada (TC). Una herramienta de pronóstico obtenida de esta podría ser un predictor útil de mortalidad.ObjetivosEvaluar los hallazgos de la TC de tórax entre los pacientes sobrevivientes y no sobrevivientes con COVID-19 y la utilidad clínica de una puntuación de TC. Métodos: Del 1 de abril al 25 de julio de 2020 se incluyeron 124 pacientes hospitalizados con infección confirmada por SARS-CoV-2. Resultados:Las opacidades en vidrio deslustrado fueron el principal hallazgo típico en los sobrevivientes (75%), mientras que el patrón de “crazy paving” o empedrado fue el principal hallazgo típico en los no sobrevivientes (65%). Los hallazgos atípicos estuvieron presentes hasta en el 46% de los pacientes. Hubo una relación directamente proporcional entre la puntuación de la TC de tórax y la mortalidad, teniendo en cuenta un punto de corte óptimo de la puntuación de la TC de 18 para predecir la muerte con una sensibilidad del 70% [intervalo de confianza (IC) del 95%: 47%-87%]. Conclusiones: Nuestros datos sugieren una mayor prevalencia de lesiones atípicas en esta cohorte. La puntuación de la TC de tórax tuvo una alta sensibilidad para predecir la mortalidad hospitalaria.(AU)

Background: Many patients with coronavirus disease 2019 (COVID-19) have been diagnosed with computed tomography (CT). A prognostic tool based on CT findings could be useful for predicting death from COVID-19. Objectives: To compare the chest CT findings of patients who survived COVID-19 versus those of patients who died of COVID-19 and to determine the usefulness the clinical usefulness of a CT scoring system for COVID-19. Methods: We included 124 patients with confirmed SARS-CoV-2 infections who were hospitalized between April 1, 2020 and July 25, 2020. Results: Whereas ground-glass opacities were the most common characteristic finding in survivors (75%), crazy paving was the most characteristic finding in non-survivors (65%). Atypical findings were present in 46% of patients. The chest CT score was directly proportional to mortality; a score≥18 was the best cutoff for predicting death, yielding 70% sensitivity (95%CI: 47%-87%). Conclusions: Our results suggest that atypical lesions are more prevalent in this cohort. The chest CT score had high sensitivity for predicting hospital mortality.(AU)

TUNEL-positive cells in the surgical border of an amputation due to infected diabetic foot.

Diabetic infected foot is the outcome of progressive vascular and neurological damage caused by persistent chronic hyperglycemia. Due to acute hypoxia and infection, the tissues develop extensive necrosis and gangrene, which often require amputation. The decision regarding the level of amputation relies mainly on the personal experience of the surgeon who must identify the healthy tissue without necrosis. However, tissue cells under stress may succumb before clear evidence of necrosis is present. In this study, dying cells with DNA damage were identified in the necrotic lesions and surgical borders of amputations. Therefore, the main purpose of this study was to identify apoptosis in the surgical borders of amputations required to treat infected diabetic foot. Apoptosis was identified by terminal deoxynucleotidyl transferase-mediated bio-dUTP nick-end labeling (TUNEL) in the superficial and deep tissues of wounds, and in the surgical borders of 10 consecutive adult patients with diabetes mellitus type 2 (DM2) who underwent amputation due to infected diabetic foot. The severity of the disease was classified by the Acute Physiological and Chronic Health Evaluation II (APACHE II) score on admission, and laboratory data were collected and bacteriological cultures were obtained from the lesions. The ankle/arm blood pressure index was measured, the blood flow in the affected limb was evaluated by high-resolution ultrasonography and color Doppler and pulse oximetry were performed during surgery. A total of 5 males and 5 females, aged 45-84 years (58.8 ± 14.1), were included. The APACHE II score was 2-18 points (8 ± 5.7). A total of 9 patients developed sepsis and 2 succumbed. A total of 5 patients required above-ankle amputation, and 5 required toe disarticulation. The ankle/arm blood pressure index ranged from 0.23-0.85 (0.51 ± 0.23). Apoptotic cells were found in ulcers and abscesses, and in areas without necrosis. In the surgical borders of the amputations, apoptotic cells were found in skeletal muscle, blood vessels and peripheral nerves, particularly Schwann cells. Morphometric analysis revealed that the extent of apoptosis was 2-3 logarithms higher in the surgical borders of the infected diabetic foot compared to the venous ulcers, which were used as the reference. In conclusion, apoptosis was identified in regenerating tissues within diabetic foot wounds and in the surgical borders of amputations, where the surgeon considered the tissues to be undamaged. This information suggests that apoptosis may be present before visible signs of necrosis appear in the diabetic foot and may be caused by hypoxia, acidosis or proinflammatory cytokines. The extent of apoptosis in tissues proximal to necrotic areas may anticipate the development of diabetic foot and help the surgeon to make decisions regarding the need and extent of amputation.