Accuracy of salivary biomarkers in the diagnosis of periodontal status and coronary heart disease.

Inflammatory illnesses, such as periodontitis and atherosclerotic coronary heart disease (ASCHD), trigger the production of pro-inflammatory mediators. The aim of this study was to assess the accuracy of using salivary interleukin-1ß (IL-1ß), interleukin-18 (IL-18), and gasdermin D (GSDMD) in discerning patients with periodontitis with and without ASCHD from healthy individuals, and to assess their correlation with clinical periodontal parameters and low-density lipoprotein (LDL) levels. The study involved 120 participants: 30 were healthy subjects (control group, C), 30 had generalized periodontitis (group P), 30 had ASCHD and clinically healthy periodontium (group AS-C), and 30 had ASCHD and generalized periodontitis (group AS-P). Saliva and blood samples were collected, and periodontal characteristics such as plaque index, bleeding on probing, probing pocket depth, and clinical attachment loss were examined. IL-1ß, IL-18, and GSDMD levels from saliva were determined using ELISA. LDL levels were determined from the blood samples. Groups P, AS-C, and AS-P had higher levels of salivary IL-1ß, IL-18, and GSDMD than group C. The receiver operating characteristic (ROC) curves of all biomarkers showed high diagnostic accuracy, with a significant positive correlation with the clinical parameters and LDL levels. The observed correlations between the studied pro-inflammatory mediators and disease severity suggest that these biomarkers could serve as indicators of disease progression in conditions such as periodontitis and ASCHD.

Cerebral Computed Tomographic Findings in Schizophrenia: Relationship to Second-Generation Antipsychotics and Hyperprolactinemia.

Antipsychotic medications are essential for managing severe mental illnesses like schizophrenia, which impacts about 1% of the global population. Despite efficacy, in some cases, they can induce hyperprolactinemia, affecting roughly half of the patients. The prevalence of this condition varies with the specific medication used. Although prolactinomas are rare among schizophrenia patients, treating them with dopamine agonists poses conflicts with antipsychotic medication, necessitating careful monitoring and adjustments. The aim of this study was to explore the presence of brain tumors, prolactinomas, and other structural brain changes in schizophrenia patients treated with second-generation antipsychotics using cerebral computed tomography (CT) scans. We conducted a cross-sectional study involving 152 hospitalized patients diagnosed between 1 January 2020 and 31 March 2024. Evaluations included cerebral CT scans, prolactin level assessments, and the monitoring of side effects. Patients, with an average age of 42.79 years and an illness duration of 17.89 years, predominantly received olanzapine (46.05%) and risperidone (36.84%). Side effects, reported by 61.78% of patients, included tremors, dizziness, and weight gain. Abnormal prolactin levels were observed in 53.95% of patients, more prevalent in females on risperidone and in both genders on olanzapine. No prolactinomas were detected on CT scans. Managing hyperprolactinemia in schizophrenia patients undergoing antipsychotic therapy is essential to prevent long-term complications and to ensure treatment compliance.

Late-Onset Manifestations of Von Hippel-Lindau Syndrome: A Case Report.

Von Hippel-Lindau (VHL) syndrome is characterized by a range of tumors including phaeochromocytomas, pancreatic adenomas, cerebellar haemangioblastomas, and renal cell carcinomas. A 50-year-old male presented with a three-week history of headache. Additionally, the patient exhibited signs of hypertension. Ultrasonography (USG) abdomen and pelvis showed a solid mass lesion in the left adrenal gland, iso-echoic to the renal cortex. On contrast-enhanced computed tomography (CECT) of the brain, a well-defined solid cystic lesion was seen in the left posterior cerebellar hemisphere. Small nodular enhancing lesions were seen in the right cerebellar hemisphere. On further imaging with MRI brain contrast, the lesions in the cerebellum were diagnosed as multifocal hemangioblastomas. Laboratory investigations revealed elevated urinary metanephrines and normetanephrine, suggesting pheochromocytoma. Based on radiological and biochemical investigations, with the features of cerebellar haemangioblastomas and pheochromocytoma, a diagnosis of VHL syndrome was made.

Thyroid Density in CT Imaging as a Potential Marker of Lung Involvement in COVID-19: A Retrospective Analysis.

Background The SARS-CoV-2 pandemic has underscored the multifaceted impact of the virus on human health, extending beyond the respiratory system to involve other organ systems, including the endocrine system. Emerging evidence suggests a notable interaction between COVID-19 and thyroid function, characterized by alterations in thyroid hormone levels and structural changes within the gland. This study aims to explore the association between thyroid density on CT imaging and lung involvement in patients with COVID-19, potentially offering new insights into the systemic effects of the virus. Methodology A retrospective cross-sectional analysis was conducted on 1,066 patients with COVID-19 who underwent chest CT scans without contrast at Government Medical College, Omandurar Government Estate, Chennai, which was designated as the COVID-19 care center from April to June 2021. Thyroid density and lung involvement were quantitatively assessed, and their correlation was analyzed using descriptive and inferential statistics, including the Kruskal-Wallis H test and Shapiro-Wilk test for normality. Results The study population predominantly exhibited normal thyroid density (749, 70.3%), followed by altered (212, 19.9%), nodular (104, 9.8%), and a single instance (0.1%) of absent thyroid density. Despite variability in lung involvement across different thyroid density categories, statistical analysis revealed no significant association between thyroid density and the extent of lung involvement in patients with COVID-19. Conclusions This study found no significant correlation between thyroid density and lung involvement in patients with COVID-19, suggesting that thyroid density on CT imaging may not serve as a reliable marker for lung involvement in this population. Further research is warranted to explore the complex interactions between COVID-19 and thyroid function, as well as the potential implications for patient management and prognosis.

Role of MRI in Evaluation of Tongue and Hypopharyngeal Lesions.

Tongue is a complex, principally muscular structure extending from oral cavity to oropharynx. Hypopharynx extends from the level of hyoid bone and to the level of inferior margin of cricoid cartilage and is divided into pyriform sinus, posterior cricoid region and posterior pharyngeal wall. Lesions that can affect the tongue and hypopharynx include neoplastic, congenital, vascular and infectious etiologies. Imaging provides crucial details for diagnosis and the appropriate management of these lesions. To evaluate the role of MRI in characterisation of benign and malignant lesions of tongue, malignant lesions of hypopharynx and staging the neoplastic lesions. The study was performed on 60 patients suspected of tongue and hypopharyngeal lesions in Dr Ram Manohar Lohia Hospital, New Delhi from 1st January 2021 to 31st May 2022. The study was done on SEIMENS skyra MRI scanner. Radiological characteristics, clinical features were studied and statistical inference was interrogated. Out of 60 patients, 32 were of tongue cancer, 10 of base of tongue cancer, 8 of hypopharyngeal cancer, 8 of hemangioma tongue and 2 of thyroglossal cyst. The mean age of our study population was 42.87 years. The qualitative analysis between diffusion restriction and histopathological examination shows a strong and substantial agreement between the two variables and a p value of 0.0014. The overall diagnostic accuracy of MRI was 85.5% and for CT was 82.5%. MRI plays an important role in differentiation of benign from malignant lesions of tongue and hypopharynx and staging of the malignant lesions. The correlation between MRI and CT findings of malignant lesions of tongue and hypopharynx indicated that both CECT and MRI have high diagnostic accuracy in diagnosing and staging but MRI is better for T and N staging of the malignant lesions with a diagnostic accuracy of 85.5% which was higher than the diagnostic accuracy of CT (82.5%). Thus, in conclusion MRI has a remarkable role in characterization and staging of benign and malignant lesions of tongue and hypopharynx. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04532-y.

Ultrasound accuracy in evaluating renal calculi in Maysan province.

Renal calculi are a common clinical presentation. While ultrasound (US) is a widely used imaging modality for kidney stone diagnosis due to its accessibility and lower cost, its accuracy compared to computerized tomography (CT), the gold standard, remains understudied. This cross-sectional study evaluated the diagnostic accuracy of ultrasound for detecting and characterizing kidney stones compared to computed tomography (CT). Fifty-six patients with suspected kidney stones based on flank pain underwent abdominal ultrasound to assess stone presence, size, location, and the severity of any hydronephrosis (kidney swelling). These findings were then confirmed with a subsequent non-contrast CT scan. There was a fair agreement between US and CT (Kappa = 0.368) for detecting the stone location. The US could not detect 7 (12.5%) stones, being less sensitive in the middle and upper calyx compared to CT. There was a fair agreement between the US and CT (Kappa = 0.394) for detecting the severity of hydronephrosis. The US was less sensitive to moderate and severe hydronephrosis compared to CT. The abdominal ultrasound demonstrated excellent reliability for stone size measurement (intraclass correlation = 0.924), with CT measurements only slightly larger on average (mean difference 0.9 mm). Although abdominal ultrasound provides reliable stone size assessment, its capacity to accurately localize stones and assess hydronephrosis severity is limited.

Beyond the Bony Fragment: A Review of Limbus Vertebra.

Vertebral limbus is a condition characterized by the intraspongious herniation of a portion of the nucleus pulposus. It is often asymptomatic, but it can sometimes cause nonspecific symptoms such as local pain and muscle spasm, or, in rare cases, radiculopathies, which is why it can be confused with vertebral fractures, spondyloarthropathies, infectious or tumoral processes. Early recognition of this pathology is preferable for a correct diagnosis and adequate treatment, the latter ranging from conservative approaches (such as personalized exercise programs and physical therapy) to surgical interventions reserved for severe cases with nerve compression.

Brain Abnormalities in Schizophrenia: A Comparative Imagistic Study.

Background and Objectives: Neuroimaging reveals a link between psychiatric conditions and brain structural-functional changes, prompting a paradigm shift in viewing schizophrenia as a neurodevelopmental disorder. This study aims to identify and compare structural brain changes found during the first schizophrenia episode with those found after more than 5 years of illness. Materials and Methods: This prospective study involved 149 participants enrolled between 1 January 2019 and 31 December 2021. The participants were categorized into three groups: the first comprises 51 individuals with an initial psychotic episode, the second consists of 49 patients diagnosed with schizophrenia for over 5 years, and a control group comprising 50 individuals without a diagnosis of schizophrenia or any other psychotic disorder. All participants underwent brain CT examinations. Results: The study examined all three groups: first-episode schizophrenia (FES), schizophrenia (SCZ), and the control group. The FES group had a mean age of 26.35 years and a mean duration of illness of 1.2 years. The SCZ group, with a mean age of 40.08 years, had been diagnosed with schizophrenia for an average of 15.12 years. The control group, with a mean age of 34.60 years, had no schizophrenia diagnosis. Structural measurements revealed widening of frontal horns and lateral ventricles in the SCZ group compared to FES and the FES group compared to the control group. Differences in the dimensions of the third ventricle were noted between SCZ and FES, while no distinction was observed between FES and the control group. The fourth ventricle had similar measurements in FES and SCZ groups, both exceeding those of the control group. Our results showed higher densities in the frontal lobe in schizophrenia patients compared to FES and the control group, with the control group consistently displaying the lowest densities. Conclusions: In summary, our comparative imaging analysis of schizophrenia patients, first-episode schizophrenia, and control patients revealed distinct ventricular patterns, with SCZ showing greater widening than FES and FES wider than the control group. Frontal lobe density, assessed via cerebral CT scans, indicated a higher density in the SCZ group in both anterior and posterior cortex portions compared to FES and the control group, while the left posterior cortex in FES had the highest density. These findings highlight unique neuroanatomical features across groups, shedding light on structural differences associated with different stages of schizophrenia.

Clinical Management of Mantle Cell Lymphoma With Concurrent Vascular Complications: A Case Report.

This is a case of a 70-year-old patient with no past medical history but a significant family history of cancer, who was admitted with acute pulmonary embolism and left lower extremity deep vein thrombosis concerning malignancy. Further investigations revealed mantle cell lymphoma. This case highlights the complex clinical management of patients presenting with concurrent hematological malignancy and vascular complications.

Long-Term Complete Response with Single-Agent Capecitabine in Her-2-neu-Positive Metastatic Breast Cancer-A Rare Case Report.

The standard treatment approach for metastatic breast cancer with HR- and Her-2-neu + disease is trastuzumab with systemic therapy. But in patients having severe cardiac dysfunction, trastuzumab is avoided. Various combination regimens are available in that setting, but no study has shown better efficacy of capecitabine monotherapy in this setting. We hereby present a case report of using capecitabine monotherapy in first-line setting, and the patient had complete resolution of lung metastasis from the last 2 years. A 64-year-old postmenopausal lady with a known case of breast carcinoma in the left side diagnosed in the year 2016 with hormone receptor-positive, Her2-negative disease completed chemoradiation and on is aromatase inhibitor from the last 5 years. She complained of breathlessness and fatigue lasting for 1 month in July 2021. On evaluation, chest CT scan revealed multiple bilateral lung metastases along with 3×3 cm right-sided breast lump with no metastasis elsewhere in the body. Core needle biopsy of breast lump and CT-guided left lung nodule biopsy were performed which revealed infiltrating carcinoma with immunohistochemical markers showing tumor cells positive for Her-2-neu with hormone receptor-negative disease. PET-CT scan was done which revealed FDG avidity in bilateral lung fields and right breast lump with no disease elsewhere. Her echocardiography showed ejection fraction of 40% owing to which injection trastuzumab was deferred and the plan to start tablet capecitabine 1000 mg twice BD days 1-14 cycles every 21 days was made. She showed improvement in symptoms with PET-CT scan revealing resolution of lung metastasis from the last 2 years. Trastuzumab in combination with pertuzumab and taxane is the standard of care for metastatic breast carcinoma with hormone receptor-negative and Her2-positive disease. But in patients who are elderly, frail with severe cardiac dysfunction, trastuzumab-based regimen is contraindicated. No study demonstrated efficacy of capecitabine monotherapy in this subset of disease. More prospective studies are required to identify patients who can benefit from capecitabine monotherapy in first-line setting in this subset of disease. Also capecitabine usage has several advantages mainly low cost and availability in oral form, and patients can be followed up on OPD basis.

Acute Intratonsillar Abscess in an Adult: A Case Report and Literature Review.

Intratonsillar abscess (ITA) is rarely reported. Here, we present an uncommon case of acute ITA in an adult, discuss the evaluation and treatment plan, and review the ITA literature.  The abscess reported in the present study was diagnosed through a combination of clinical findings and computed tomography imaging, and treatment included drainage, intravenous (IV) clindamycin, and IV dexamethasone. The literature reports 72 ITA cases with specified treatments: 21 (29.2%) in adults, 19 (26.4%) in children, and 32 (44.4%) in patients of unspecified ages. Among them, 25 (34.7%) responded to antibiotics alone, 11 (15.3%) to needle aspiration and antibiotics, and 36 (50.0%) needed further intervention. Based on the presented case and literature review, we suggest the use of IV antibiotics with needle aspiration as the primary treatment for acute ITA. Incision and drainage (I&D) with antibiotics should be reserved for cases unresponsive to initial measures, and tonsillectomy is recommended for recurrent post-I&D cases.

Establishing Baseline Radiological Metrics of the Talus and Calcaneus: A Retrospective Analysis of Computed Tomography Imaging in an Irish Cohort.

Introduction The subtalar joint anatomy is complex and heterogeneity in its morphology creates unique challenges for foot and ankle surgeons. Anatomical metrics used for prosthesis design are well established. However, there is a paucity of literature quantifying foot and ankle measurement techniques and metrics used for prosthesis design. The aim of this study was to document reproducible measurement techniques and quantify talar and calcaneal metrics in a sample of Irish patients on computed tomography imaging to aid in the design of a novel hindfoot plate. Methods A retrospective analysis of consecutive foot and ankle computed tomography images performed at our institution was undertaken. Five measurements were performed on each foot and ankle image. Statistical analysis was performed to identify if a correlation existed between measurements. Results Sixty-four CTs met the inclusion criteria. Talar body height 27.1 mm (SD 2.17 mm), talar neck width 32.7 mm (3.16 mm), talar head height 25.41 (SD 2.16 mm), lateral process to posterior talus 23.6 (2.64 mm), calcaneal height 43.8 mm (SD 3.9 mm). A positive correlation was identified between all measurements. Conclusion This study identified that there was a low degree of heterogeneity in talar and calcaneal measurements in an Irish cohort. Furthermore, the metrics used in this study will provide valuable information for the preliminary design of a novel hindfoot plate.

Serum biomarkers to predict hemorrhagic transformation and ischemic stroke outcomes in a prospective cohort study.

Ischemic stroke (IS) remains one of the most frequent causes of death and disability worldwide. Identifying possible prognosis factors for IS outcomes, including hemorrhagic transformation (HT), could improve patients' recovery. This study aimed to investigate the potential prognosis role of non-specific laboratory data at admission and baseline MMP-2 and MMP-9 serum levels in predicting HT risk, discharge, and 3-month follow-up status of IS patients. Data from 150 successive acute cerebral infarction patients were analyzed in a prospective cohort study. The active group included patients who developed HT during hospitalization (55 persons). There were no significant differences in age, gender distribution, time to admission, or time to blood sample collection for MMPs measurement between patients in the active and control groups. IS patients from the active group had a significantly higher rate of AF (atrial fibrillation) in the past (p=0.003), while differences in other factors such as diabetes, hypertension, myocardial infarction, previous stroke, obesity, smoking, and alcohol were not significant. Admission NIHSS score and mRS (modified Rankin Scale) values (at discharge and 90 days) were significantly worse in the active group (p<0.001). Among the analyzed admission laboratory factors (glycemia, lipid profile, coagulation panel, inflammatory reaction parameters, MMP-2, MMP-9), INR presented an inverse correlation, with lower values in the HT cohort (univariate analysis - p=0.01, OR=0.11; multivariate analysis - p=0.03, OR=0.09). Further research on larger cohorts is warranted to determine the specific laboratory biomarkers for predicting hemorrhagic transformation and ischemic stroke outcomes.

COVID-19 in patients with rheumatological diseases in the Eastern Province of Saudi Arabia.

The severity of the 2019 coronavirus disease (COVID-19) and its effects remain unpredictable. Certain factors, such as obesity, hypertension, and type 2 diabetes mellitus, may increase the severity of the disease. Rheumatology experts suggest that patients with active autoimmune conditions and controlled autoimmune diseases on immunosuppressive therapy may be at higher risk of developing severe COVID-19. In this retrospective observational study, we aimed to examine the patterns of COVID-19 in patients with underlying rheumatological diseases and their association with disease severity and hospital outcomes. A total of 34 patients with underlying rheumatological diseases who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR) were included between March 2020 and April 2021 at King Fahd Hospital of the University. The study population consisted of 76.47% female and 23.53% male patients, with a mean age ranging from 20 to 40 years. Female gender (p=0.0001) and younger age (p=0.004) were associated with milder disease. The most frequent rheumatological disease was systemic lupus erythematosus (SLE) (38.24%), which was associated with a milder infection (p=0.045). Patients treated with mycophenolate mofetil (MMF) had a milder disease course (p=0.0037). Hypertension was significantly associated with severe COVID-19 disease (p=0.037). There was no significant relationship between SLE and the need for ICU admission. Patients on hydroxychloroquine and MMF tended to develop milder disease, and there was no association between the severity of the infection and the treatment with steroids.

Management of an accidental penetrating cardiac injury in a 4-year-old girl.

INTRODUCTION: Penetrating cardiac injuries are a significant challenge for surgeons and can have varying outcomes depending on factors such as initial care, characteristics of the wounds, and surgical management. These injuries can result from both stab wounds and gunshot wounds, with different mortality rates associated with each. Life-threatening illnesses include penetrating injuries to the heart. CASE PRESENTATION: We present here A 4-year-old child who was injured by a pencil while running and falling on the ground presented to our emergency room with a piercing injury in the right third ICS. She was awake but had trouble breathing when they got there. DISCUSSION: Penetrating cardiac injuries can also occur as a result of intentional penetration or accidental direct penetration of foreign bodies into the heart. The main pathophysiological determinant for most survivors is acute pericardial tamponade, which can lead to shock and hemodynamic instability. This case report contributes to the current literature when any patient has a penetrating injury in the cardiac box and is highly suspect of a cardiac injury, regardless of the material of the injury. To increase health education among people, never try to remove any material stuck in the body until the patient has a suitable place and equipment. CONCLUSION: Penetrating cardiac injuries are severe and life-threatening conditions that require prompt diagnosis and management, which in most cases need surgical treatment is required. To improve outcomes for patients with penetrating heart injuries, further research and improvements in diagnostic and treatment methods are required.

Osteomyelitis of the Clivus Secondary to Mucormycosis.

Osteomyelitis of the clivus secondary to mucormycosis is a rare infection of the clivus bone due to infiltration by fungi of the genus Mucor. Immunocompromised patients and/or those with diabetes mellitus are most at risk of developing this disease. Here, we present the case of a 63-year-old male patient with findings of gas within the clivus on computed tomography angiography. Diagnosis of mucormycosis osteomyelitis was confirmed after endoscopic biopsy and histopathologic examination. Furthermore, as this condition is very difficult to detect on imaging, we emphasize the discussion of typical radiology findings associated with this disease based on this and other case reports in the literature.

Computerized Tomography Texture Analysis in the Differential Diagnosis of Intracranial Epidermoid and Arachnoid Cysts.

PURPOSE: This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA). MATERIAL AND METHODS: The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances. RESULTS: The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%. CONCLUSION: CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.

Delayed Metastatic Cholangiocarcinoma to the Stomach With Imaging Characteristics Resembling Gastrointestinal Stromal Tumor: A Case Report and Review of the Literature.

Intrahepatic cholangiocarcinoma (ICC) is a relatively rare subtype of cholangiocarcinoma, and there has been an increasing incidence of ICC in Western countries in recent years. Surgical resection is the most effective treatment for ICC. However, overall outcomes are extremely poor given that most patients are diagnosed at an advanced stage, and postoperative ICC recurrence is still very high despite hepatic resection. We report a case of metastatic ICC to the stomach presenting after resection of the original tumor, with imaging characteristics highly resembling gastrointestinal stromal tumor (GIST) on imaging. Reported cases of metastatic ICC to the liver are sparse. Given that there is a significant difference in the survival rate between metastatic cholangiocarcinoma and other tumors arising from the gastrointestinal tract, including GISTs, it is important to delineate the differences via imaging features. We further discuss the imaging characteristics of intrahepatic ICC, comparing and contrasting it to other gastric tumors.

Comparison between the accuracy of chest computerized tomography vs. reverse transcriptase polymerase chain reaction in a tertiary care center in Lebanon; along with their correlation to mortality, morbidity and symptoms in COVID-19 patients.

Objectives: Chest Computerized Tomography has been widely used in COVID patients' assessment. Hence the question arises as to whether there is any correlation between the Ct value and findings on Chest CT scan or clinical presentation of the patient. We wanted to test the hypothesis of whether low Ct values (≤30) in RT-PCR were associated with a high mortality rate, CT scan findings, or with comorbidities such as immunosuppression and lung disease. Methods: The radiographic records and RT-PCR Ct values of 371 COVID patents diagnosed at the American University of Beirut Medical Center were reviewed. Results: We found out that the sensitivity of chest CT scan compared to RT-PCR, the gold standard, turned out to be 74% (95% CI 69-79%). Specificity, on the other hand was 33% (95% CI 16-55%). The positive predictive value of CT was 94% (95% CI 91-97%) and the negative predictive value was 8% (95% CI 4-16%). low Ct values in RT-PCR were not associated with a higher mortality rate (p-value = 0.416). There was no significant positive association between low Ct value and suspicious CT scan findings (typical and indeterminate for COVID-19), with a p-value of 0.078. There was also no significant association between low Ct value and immunosuppression (p-value = 0.511), or lung disease (p-value =0.06). CT scan findings whether suspicious or not for COVID-19 infection, were not shown to be significantly associated with respiratory symptoms of any kind.No association was found between a history of lung disease, immunosuppression and suspicious CT scan findings for COVID-19. Conclusion: As long as this pandemic exists, nucleic acid testing was and remains the gold standard of COVID-19 diagnosis worldwide and in our community as it has a superior diagnostic accuracy to CT scan and higher sensitivity (94% vs 74%).

The Role of Computed Tomography in the Management of Hospitalized Patients With COVID-19.

The emergence of SARS-CoV-2 at the end of 2019 sparked the beginning of the COVID-19 pandemic. Even though it was a novel virus, the workup of suspected COVID-19 included standard protocols used for the investigation of similar respiratory infections and pneumonia. One of the most important diagnostic tests in this regard is computed tomography (CT). CT scans have a high sensitivity in diagnosing COVID-19, and many of the characteristic imaging findings of COVID-19 are used in its diagnosis. The role of CT in COVID-19 management is expanding as more and more hospital practices adopt regular CT use in both the initial workup and continued care of COVID-19 patients. CT has helped hospitalists diagnose complications such as pulmonary embolism, subcutaneous emphysema, pneumomediastinum, pneumothoraces, and nosocomial pneumonia. Although mainly used as a diagnostic tool, the prognostic role of CT in COVID-19 patients is developing. In this review, we explore the role of CT in the management of hospitalized patients with COVID-19, specifically elucidating its use as a diagnostic and prognostic modality, as well as its ability to guide hospital decision-making regarding complex cases. We will highlight important time points when CT scans are used: the initial encounter, the time at admission, and during hospitalization.