Diaphragmatic ultrasonography in patients with IPF: Is diaphragmatic structure and mobility related to fibrosis severity and pulmonary functional changes?

Introduction: There is evidence to suggest that dyspnea and impaired exercise capacity are associated with respiratory muscle dysfunction in idiopathic pulmonary fibrosis (IPF) patients. We aimed to evaluate the functions of the diaphragm with ultrasonography (US) and to determine the correlation of the data obtained with the pulmonary function parameters of the patients, exercise capacity, and the extent of fibrosis radiologically. Materials and Methods: Diaphragmatic mobility, thickness, and thickening fraction (TF) were measured by ultrasonography in IPF patients and the control group. The correlation between these measurements, pulmonary function tests (PFT), six-minute walking test (6MWT), mMRC score, and total fibrosis score (TFS) was evaluated. Result: Forty-one IPF patients and twenty-one healthy volunteers were included in the study. No difference was found between the patient and control groups in diaphragmatic mobility during quiet breathing (QB) on ultrasound (2.35 cm and 2.56 cm; p= 0.29). Diaphragmatic mobility during deep breathing (DB) was found to be lower in the patient group when compared to the control group (5.02 cm and 7.66 cm; p<0.0001). Diaphragmatic thickness was found to be higher during QB and DB in IPF patients (0.33 cm and 0.31 cm, p= 0.043; 0.24 cm and 0.22 cm, p= 0.045). No difference was found between the two groups in terms of thickening fraction (39.37%, 44.16%; p= 0.49). No significant correlation was found between US measurements and PFT, 6MWT, mMRC score, and TFS in IPF patients (p> 0.05). Conclusions: The functions of the diaphragm do not appear to be affected in patients with mild-to-moderate restrictive IPF. This study showed that there was no relationship between diaphragmatic functions and respiratory function parameters and the extent of fibrosis. Further studies, including advanced stages of the disease, are needed to understand the changes in diaphragmatic functions in IPF and to determine whether this change is associated with respiratory function parameters and the extent of fibrosis.

Comparison of Initial CT Findings and CO-RADS Stage in COVID-19 Patients with PCR, Inflammation and Coagulation Parameters in Diagnostic and Prognostic Perspectives.

Objectives: This study aims to determine whether COVID-19 patients with different initial reverse transcriptase-polymerase chain reaction (RT-PCR), computed tomography (CT) and laboratory findings have different clinical outcomes. Materials and Methods: In this multi-center retrospective cohort study, 895 hospitalized patients with the diagnosis of COVID-19 were included. According to the RT-PCR positivity and presence of CT findings, the patients were divided into four groups. These groups were compared in terms of mortality and need for intensive care unit (ICU). According to the COVID-19 Reporting and Data System (CO-RADS), all patients' CT images were staged. Multivariate binary logistic regression analysis was used to examine the relationship between CO-RADS and predictive inflammation and coagulation parameters. Results: RT-PCR test positivity was 51.5%, the CT finding was 70.7%, and 49.7% of the patients were in the CO-RADS 5 stage. The need for ICU and mortality rates was higher in the group with only CT findings compared to the group with only RT-PCR positivity, (14.9% vs. 4.0%, p < 0.001; 9.3% vs. 3.3%, p > 0.05; respectively). Mortality was 3.27 times higher in patients with CO-RADS 4 compared to those with CO-RADS 1-2. Being in the CO-RADS 4 stage and LDH were discovered to be the most efficient parameters in determining mortality risk. Conclusion: Performing only the RT-PCR test in the initial evaluation of patients in SARS-CoV-2 infection may lead to overlooking groups that are more at risk for severe disease. The use of a chest CT to perform CO-RADS staging would be beneficial in terms of providing both diagnostic and prognostic information.

CT visual quantitative evaluation of hypertensive patients with coronavirus disease (COVID-19): Potential influence of angiotensin converting enzyme inhibitors / angiotensin receptor blockers on severity of lung involvement.

OBJECTIVE: There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications. METHODS: : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups. RESULTS: In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) (p < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) (p < .001). Excellent agreement was established between the two blinded observers in the TSS measurements. CONCLUSIONS: Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.