Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity.

BACKGROUND: The classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment. METHODS: This was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease. RESULTS: Patient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = - 0.245, P = 0.005), lymphocytes% (r = - 0.586, P < 0.001), RBCs (r = - 0.2488, P = 0.005), Hb (gm/dl) (r = - 0.342, P < 0.001), and HCT (r = - 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation. CONCLUSION: Clinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.

Prognostic Factors for Hormone Sensitive Metastatic Prostate Cancer: Impact of Disease Volume

Background and Aim: The optimal management of metastatic hormone-sensitive prostate cancer has been controversial in recent years with introduction of upfront chemohormonal treatment based on results of several Western studies. This changing landscape has renewed interest in the concept "disease volume", the focus of the present study is the Egyptian patients. Methods: Patients with hormone sensitive metastatic prostate cancer presenting at Menoufia University Hospital, Egypt, during the period from June 2013 to May 2016, were enrolled. All received hormonal treatment. Radiologic images were evaluated and patients were stratified according to their disease volume into high or low, other clinical and pathological data that could affect survival also being collected and analyzed. Results: A total of 128 patients were included, with a median age of 70 years (53.9% ≥70). About 46% had co-morbidities, 62% having high volume disease. During the median follow up period of 28 months about half of the patients progressed and one third received chemotherapy. On univariate analysis, disease volume, performance status (PS), prostate specific antigen level (PSA) and presence of pain at presentation were identified as factors influencing overall survival. Multivariate analysis revealed the independent predictor factors for survival to be PS, PSA and disease volume. The median overall survival with 27 months was high volume versus 49 with low volume disease (hazard ratio 2.1; 95% CI 1.2 - 4.4; P=0.02). Median progression free survival was 19 months in the high volume, as compared with 48 months in the low volume disease patients (hazard ratio, 2.44; 95% CI, 1.42 ­ 7.4; P=0.009). Conclusions: Disease volume is a reliable predictor of survival which should be incorporated with other important factors as; patient performance status and comorbidities in treatment decision-making.